
Qass. 
Book 



COPYRIGHT DEPOSIT 



Skin Diseases 

THEIR 

DESCRIPTION, ETIOLOGY, DIAGNOSIS. 

AND TREATMENT 

ACCORDING TO THE LAW OF THE SIMILARS. 



BY 

M; E. DOUGLASS, M. D., 

Baltimore, Mb., 

LEcxrRER ON Dermatology in the Southern Homceopath 
Medical College of Baltimore, Md. 



PHILADBlvPHIA : 
BOERICKE & TAFEL. 
'*• '■ ■ 1900. 



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COPYRIGHT 
BY 

BOERICKE & TAFEL, 
1900. 



T. B. & H. B. COCHRAN, PRINTERS, 
LANCASTER, PA. 



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PREPACK. 



Man is a composite being. We have the skeletal man ; 
the muscular man; the arterial man; the nervous man; 
the venous man; and enclosing and protecting all these 
the skin— or outer man. This outer man is the one in 
whom we all take a greater or lesser pride; the one that 
receives the greatest amount of attention; the one that 
more pains are taken to beautify and adorn than all the 
others; the one in which any imperfection is soonest 
noticed, and for which relief is most promptly sought. 

The physician who can soonest remove the disfiguring 
blemishes, heal diseased conditions, smooth and beautify 
the skin is the one whose praises are the loudest pro- 
claimed by the gratified patient. 

In no other department of medical science is a reputa- 
tion so readily made as in the department of dermatology, 
for the reason that patients can speedily judge whether 
the physician is likely to do them good or harm. 

What not to do in treating skin diseases is an import- 
ant thing to know. The physician must have a thorough 
knowledge of the general course and behaviour of skin 
diseases, and it is essential that he should be proficient 
in the principles of general medicine, in order that he 
may treat affections of the skin intelligently and success- 
fully. The reason for this statement will become ap- 
parent as we study the etiology of the various lesions. 
We will then find that it often is necessary only to treat 
the cause to remove the lesion; and in this branch of 



IV PREFACE. 

medical science, more than in any other, perhaps, we will 
find Hahnemann's rule to treat the totality of the symp- 
toms complained of by the patient, the only method by 
which we may cure our patient. 

" The highest aim of healing is the speedy, gentle, and 
permanent restitution of health, or alleviation and oblitera- 
tion of disease in its entire extent, in the shortest, most 
reliable, and safest manner, according to clearly intel- 
ligible reasons. ' ' 

'* When the physician knows in each case the obstacles 
in the way of recovery, and how to remove them, he is 
prepared to act thoroughly, and to the purpose, as a true 
master of the art of healing." 

The author has been prompted to prepare this work by 
a conviction of the existence of an urgent demand for a 
work on Dermatology in our School of Medicine, which 
should embody the advances recently made and set forth 
the distinctive characters of our therapeutics in a rational 
and practical manner. 

The work has been written in the first instance with 
the view of meeting the wants of the homoeopathic prac- 
titioner in his daily dealings with diseases of the skin; 
at the same time the needs of the medical student in pre- 
paring for his examinations has been kept constantly in 
mind. 

The author has endeavored to present his subject in 
the most practical manner and with the fewest possible 
words consistent with an intelligible presentation of the 
same. To this end he has avoided all theoretical and con- 
troversial discussions, which are of interest to the special- 
ist rather than to the general practitioner or student. 

7 W. North Ave. 
May, 1899. 



CONTENTS. 



CHAPTER I. 

Thh Anatomy of the Skin, 9 

Blood Vessels, 10. Epidermis, 11. Subcutaneous Cellular 
Tissue, 17. The Sweat Glands, 17. Sebaceous Glands, 20. 
Hair. 22. Muscles of the Skin, 23. Nails, 24. Nature and 
Amount of Perspiration, 28. 

CHAPTER II. 

Some General Observations, : . . . 33 

Rules for Studying Skin Diseases, 41. 

CHAPTER III. 
Classification of the Elementary Lesions, ...... 48 

Macule, 49. Vesicle, 50. Bulla, 51. Pustule, 51. Papule, 
52. Tubercle, 54. Scales, 55. Fissures, 56. Ulcers, 56. 
Drug Eruptions, 57. Pathology, 59. 

CHAPTER IV. 
Etiology, . 60 

CHAPTER V. 

Local Dermal Inflammations, 70 

Erythematous Diseases, 72. Erythema, 73. Erythema Mul- 
tiforme, 73. Erj'thema Nodosum, 75. Roseola, 79. Urti- 
caria, S2. P^ollicular Hyperaemia, 93. Medicinal Rashes, 
94. 

CHAPTER VI. 
The Eruptions of Acute Specific Diseases (Zymotic), . 96 
Variola, 96. Varicella, 107 Typhus Rash, 108. Typhoid 
Rash, 108. Measles, 109. Scarlatina, 114. Erysipelas, :i5. 
Rubella, 125. Frambcesia or Jaws, 126. 



VI CONTENTS. 



CHAPTER VII, 



Papular Infi^ammations, 129 

Lrichen Planus, 129. Ivichen Ruber, 133. L^ichen Simplex, 
135. lyichen Scrofulosorum, 141. Strophulus, 142. Prurigo, 
143- 

CHAPTER VI n. 

ECZRMA, 148 

CHAPTER IX. 

Buivi^ous Diseases and Anomalous Forms of Bullous 

Eruption, i<S9 

Herpes Labialis, 191. Herpes Progenitalis, 191. Zoster, 196. 
Pemphigus, 202. Pemphigus Vulgaris, 203. Pemphigus 
Foliaceus, 204. Hydroa, 208. 

CHAPTER X. 

Suppurative Inflammations, 215 

Impetigo Contagiosa, 216. Erthyma, 223. Furuncle, 228. 
Stye, 232. Carbuncle, 233. Pustula Maligna, 237. 

CHAPTER XI. 

Squamous Inflammations, 240 

Pityriasis Rubra, 241. Pityriasis Pilaris, 244. Psoriasis, 245. 

CHAPTER XII. 

Diathetic Diseases, 257 

vScrofuloderma, 257. Syphilis, 267. Condylomata, 288. 
Leprosy, 290. Morvan's Disease, 299. 

CHAPTER XIII. 

Hypertrophic and Atrophic Affections, 303 

Corns, 304. Horns, 305. Warts, 306. Ichthyosis, 317. Mor- 
phoea, 322. Scleroderma, 325. Scleriasis, 327. vSclerema 
Neonatorum, 328. Keloid, 328. Fibroma, 331. Derma- 
tolysis, 332. Elephantiasis, 333. Milium, 334. Mammil- 
litis Maligna, 335. Ainhum, 336. Naevus, 336, 



CONTENTS. Vll 



CHAPTER XIV. 



Neoplasmata 340 

Ivupus, 340. Epithelioma, 34S. Sarcoma, 353. Carcinoma, 
357. Rodent Ulcer, 371, 

CHAPTER XV, 

Cutaneous Hemorrhages, 374 

Purpura. 375. 

CHAPTER XVI. 
Pruritus, 379 

CHAPTER XVII. 

Chromatogenous Diseases 387 

Vitiligo, 388. Melanoderma, 389. Ephelis, 391. 

CHAPTER XVIII. 

Parasitic Diseases 377 

Phtheiriasis, 393. Psorospermosis, 396. Scabies. 396. Favus, 
402. Tricophytosis, 407. Chromophytosis, 412. Onychomy- 
cosis, 413. Paronychia, 416. 

CHAPTER XIX. 

Disorders of the Glands, 418 

Diseases of Sweat Glands, 418. Anidrosis, 421. Dysidrosis, 
423. Osmidrosis, 425. Chromidrosis, 425. Hsematidrosis, 
426. Lichen Propicns, 427. Hydro-Adenitis, 427. Sudolor- 
rhoea, 428. Seborrhoea, 430. Asteatodes, 433, Allosteado- 
des, 433. Xanthelasma, 434. Comedo, 435. Molluscum, 
436. Acne, 437. 

CHAPTER XX. 

Diseases of the Hair, 450 

Alopecia, 450. 

CHAPTER XXI. 

Pernio, 456. Actinomycosis, 459. Wash-Leather vSkiii, 460. 
Effects of Rhus Tox. on the Skin, 461. 



CHAPTER I. 



THE ANATOMY OF THE SKIN. 

In order to correctly understand the nature of the mor- 
bid changes that go on in the skin, and to comprehend 
correctly how and where these changes begin, it is nec- 
essary to have an accurate knowledge of the healthy skin 
in its different parts. 

The healthy skin is, of course, the standard of com- 
parison for all changes in the skin, and without the clear- 
est perception of what that standard is the student can, 
of course, only fall into error from the inability to distin- 
guish between what is normal and what is abnormal. 

The skin consists of an epithelium resting upon a con- 
nective tissue basis. The epithelium, which is composed 
of many layers of cells, is called epidermis^ the connective 
tissue basis is called cutis vera, dermis, or corium. The 
surface of the dermis is thrown up into a number of eleva- 
tions — papillcB — which differ in size, form, complexity, and 
arrangement in different regions of the body. Some are 
small, more or less conical elevations, simple papiUcs. In 
others, a broader primary elevation is divided at its sum- 
mit into a number of secondary elevations; these are 
compound papillcB. In many regions of the skin, as, for 
example, in the palms of the hands, the papillae are 
arranged in ridges separated by shallow furrows. The 
surface of the skin, that is, the contour of the epidermis, 
does not follow the papillary contour of the dermis; the 
papillae accordingly appear to plunge into and be covered 



10 SKIN DISEASES. 

Up by the more even epidermis, the surface of which, 
however, is marked by the ridges and furrows spoken of 
above as well as by bolder creases and folds. 

The surface of the dermis is not developed into a dis- 
tinct and separable basement membrane, as is so often the 
case in a mucous membrane; but in the most superficial 
portions of the dermis the connective tissue shows little 
or no fibrillation and consists of a homogeneous matrix, 
in which are imbedded connective tissue corpuscles and 
extremely fine elastic fibres. This superficial portion of 
the dermis, which is especially well developed in the pa- 
pillae, serves accordingly the purposes of a basement mem- 
brane, and sharply defines the dermis from the overlying 
epidermis. At a very little distance from the epidermis, 
fibrillation makes its appearance, the bundles of fibrillse 
interlacing in a network which, very closely set in the 
outer, more superficial layers, becomes more and more 
open in the inner, deeper parts. The connective tissue 
of the dermis thus passes insensibly into the subcutaneous 
connective tissue, in which thick interwoven bundles of 
fibrillse, bearing in transverse section a certain resem- 
blance to sections of tendon bundles, form a tough open 
network, the larger spaces of which are frequently occu- 
pied by masses of fat cells of the subcutaneous adipose 
tissue. Elastic fibres are very abundant in the dermis 
proper, being very fine immediately beneath the epider- 
mis and becoming coarser in the deeper parts; they are 
present also, though to a less extent, in the subcutaneous 
connective tissue. The skin, as a whole, is a very elastic 
structure. 

Blood vessels are very abundant, forming close-set 
capillary outworks and looks immediately under the epi- 
dermis, especially in the papillae, and more open net- 
works elsewhere; but no blood vessel passes into the epi- 



THE ANATOMY OF THE SKIN. 11 

dermis. Lymphatic vessels and lymphatic capillaries are 
abundant in the dermis, being connected here as in other 
regions of the body with smaller * ' lymph spaces. ' ' 

The consideration of the nerves of the skin will be 
deferred until we come to deal with the skin as an organ 
of sense; for though some of the cutaneous nerve fibres 
are efferent fibres distributed to the blood vessels, and 
probably to the sweat glands and other structures not 
directly connected with the sense of touch, by far the 
greater number are afferent fibres beginning in the dis- 
tinct tactile organs, or otherwise serving as sensory struct- 
ures. 

The epidermis consists of two parts, separated by a 
fairly sharp line of demarcation; an inner soft layer, the 
Malpighian layer, or stratmn Malpighii, and an outer 
harder horny layer, or stratum coryieum. The skin, as is 
well known, varies in thickness in dffferent regions of the 
body, and the differences are due almost exclusively to 
variations in the thickness of the horny layer which, as 
over the lips, may be extremely thin, or as on the heel, 
excessively thick; compared with the variations in thick- 
ness of the horny layer, the variations in thickness of the 
Malpighian layer or of the dermis may be disregarded. 

The line of demarcation between the Malpighian and 
horny layers follows the contour of the surface of the 
skin, not that of the dermis, the papillae of which appear 
in sections as if imbedded in the Malpighian layer. When 
the skin after death is macerated, the horny layer is apt 
to peel off from the Malpighian layer below, which, 
originally soft and rendered still softer by the macera- 
tion, then appears as a layer of slimy tissue spread out 
between the sides of and covering the summits of the 
papillae of the dermis, somewhat after the fashion of a 



12 SKIN DISEASES. 

network; hence this layer wavS in old times spoken of as 
the rete niucosimi. 

The lowermost, innermost portion of the Malpighian 
layer resting upon the dermis, consists of a single layer 
of elongated, or almost columnar cells placed vertically, 
that is, with their long axis perpendicular to the plane of 
the dermis. This layer which preserves the original feat- 
ures of the epiblast of the embryo, and which may be 
followed over the papillae as well as along the intervening 
valleys, presents a characteristic appearance in vertical 
sections of the skin. Bach cell, which is about as large 
as a leucocyte, consists of a relatively large oval nucleus 
lying in the midst of a coarsely granular cell substance, 
which stains readily with the ordinary staining reagents. 
The base of the cell abutting on the dermis often shows 
fine processes interlocking with corresponding processes 
from the dermis; the sides of the cells are in close con- 
tact, but merely in contact, no cement substance existing 
between them. 

The rest of the cells of the Malpighian layer, much like 
each other, are polygonal or irregularly cubical cells, re- 
sembling the vertical cells just spoken of in so far that 
each consists of a coarsely granular cell-substance in which 
is imbeded a relatively large nucleus; this, however, is 
spherical, not oval. The surface of each cell is thrown 
up into short ridges, radiating somewhat irregularly from 
the centre of the cell and projecting at the surface and 
edges, so as to give the cell somewhat the appearance of 
being armed with a number of prickles. Hence these 
cells are often called ' ' prickle cells. ' ' The prickles of a 
cell do not interlock with those of its neighbors but touch 
at their points, so that the contact of two adjacent cells is 
not complete but carried out by the points of the prickles 
only, minute spaces being left between. Hence the whole 



THE ANATOMY OF THE SKIN. 13 

Malpighian layer is traversed by a labyrinth of minute 
passages, along which fluid can pass between the touch- 
ing prickles. 

In dark skins, as that of the negro, pigment particles 
abound in the lower Malpighian cells, especially in the 
vertical layer. In such cases branched pigment cells, 
connective tissue corpuscles loaded with pigment gran- 
ules, are to be seen in the dermis also; and occasionally 
similar branched cells may be seen in the epidermis be- 
tween the Malpighian cells. lycucocytes also not infre- 
quently pass out at the dermis and wander among the 
cells of the Malpighian laj^er. 

The nuclei, not only of the vertical, but also of the other 
polygonal cells may, not infrequently, be observed in 
various stages of karyomitosis. Throughout life the 
cells of this Malpighian layer of the skin appear to be 
undergoing multiplication by division ; the increase of 
population thus arising is kept down by the cells passing 
upward and outward, and becoming transformed into the 
cells of the horny layer. 

The line of demarcation between the Malpighian layer 
and the horny layer is, as we have said, sharp and dis- 
tinct. It is furnished by two peculiar strata of cells, 
more conspicuous in some regions of the skin than in 
others. The lowermost, innermost stratum consists of a 
single layer or of two or three layers of cells which are 
not unlike Malpighian cells, but are differentiated by 
their form, being extended horizontally so as frequently 
to appear fusiform in vertical sections, by the absence of 
prickles, by their staining very deeply with certain re- 
agents, such a,'i osmic acid, and especially by their cell 
substance being crowded with large discrete granules of 
a peculiar nature. Hence this stratum is called the 
stratum granulosum. 



14 SKIN DISEASES. 

The stratum above this consists of two or even more 
layers of cells, elongated and flattened horizontally, the 
cell substance of which is homogeneous and transparent, 
free from granules and not staining very readily. In the 
middle of a cell may frequently be seen a rod-shaped 
nucleus placed horizontally. These clear transparent 
cells form a transparent seam, the stratum lucidum, be- 
tween the stratum granulosum and Malpighian layer 
below and the horny layer above. 

The horny layer, which is, as we have said, of variable 
but nearly always of considerable thickness, is formed of 
a number of layers of cells which, differentiated already 
in the lowest layers, have that differentiation completed 
as these pass upward. The upper, outer portion of this 
horny layer is continually being shed or rubbed off in the 
form of flakes of variable size. Each flake upon exami- 
nation, as for instance after dissociation by maceration or 
with the help of alkalies, is found to be composed of 
elements which can no longer be recognized as cells, and 
which may be spoken of as scales. Every scale is a 
flattened mass or plate in which no nucleus can be seen, 
and which consists not of the proteids and other constitu- 
ents of ordinary cell substance, but almost exclusively of 
a material called keratiyi. This is a body, the exact 
nature of which has not yet been clearly made out, but 
which has the general percentage composition of proteids, 
from which it is a derivative, with the exception that it 
contains a considerable quantity of sulphur (the keratin 
of hair contains as much as five per cent); this sulphur 
appears to be somewhat loosely attached to the other 
elements of the keratin since it may be removed by boil- 
ing with alkalies. 

The lowermost portions of the horny layer are com- 
posed of elements which may still be recognized as cells, 



THE ANATOMY OF THE SKIN. 15 

inasmuch as each contains a nucleus, though this obvi- 
ously undergoing change and on the way to disappear. 
Each cell is, however, flattened and plate-like, and its 
substance already consists largely of keratin. In passing 
upward from the lower to the more superficial pairs of 
the horny layer such an imperfect cell loses its nucleus, 
and becomes the wholly keratinous plate just described. 
The whole horny layer consists of strata of elements, 
horny to begin with, but becoming more completely so in 
the upper parts. Below, in contact with the moist Mal- 
pighian layer, the horny layer is moist but the superficial 
parts become dry by evaporation; and here the strata 
delaminate from each other, the outer ones, as we have 
said, being shed in the form of flakes, which seen in the 
dry condition under the microscope have often the ap- 
pearance of irregular fibres. 

The karyomitosis seen in the cells of the Malpighian 
layer, not only in those of the vertical layer, but in the 
others as well, show, as we have said, that these multiply 
by division; we have no evidence of multiplication taking 
place elsewhere in the epidermis. The more superficial 
cells of the Malpighian layer, thrust upward by the new- 
comers, are transformed into the cells of the stratum 
granulosum; and although we do not as yet fully under- 
stand the exact nature of the transformation we may con- 
clude that the peculiar granules of these cells are con- 
cerned in the manufacture of keratin. Changed by the 
consumption of their granules in this manufacture, the 
cells of the stratum granulosum become first the cells 
of the stratum lucidum, and then the cells of the dis- 
tinctl}^ horny layer, pushed upward through which, by 
the new formations continually succeeding below them, 
they pass to the surface and are eventually shed. 

The papillae in the papillary part vary in size and as- 



16 SKIN DISEASES. 

pect in different parts of the skin. They are pointed or 
thread-Hke about the fingers, and club-shaped or rounded 
over the general surface of the body. On the palm of the 
hand, about the nipple, and the sole of the foot, they are 
longest and largest, being often 66 to i m. They are 
shortest on the face. They are of two kinds — nervous, 
containing nerve fibres ending in tactile corpuscles, and 
vascular, containing blood-vessels in the form of a loop. 

There are, in addition, spindle-shaped cells, or cells 
anastomozing by processes, amongst the connective tissue 
bundles in the substance of the corium and around the 
vessels. 

The thickness of the corium varies. It is thinnest 
about the eyelids and prepuce; on the face, scrotum, and 
body, generally, it is thicker. On the sole of the foot and 
palm of hand it is thickest, being from 2.25-2.28 of a 
millimetre. 

The corium is well supplied with vessels, lymphatics, 
and nerves. The vessels come up from the connective 
tissue below, give off branches to the fat and the glands, 
then constitute a network which sends off more or less 
obliquely twigs to form a longitudinal plexus along the 
base of the papillae, from whence finally capillary loops 
are supplied to most of the papillse. The lymphatics have 
much the same arrangement as the blood-vessels. The 
plexuses, however, are situated beneath those formed by 
the capillaries, but no lymphatics are supplied to the 
papillae. The spaces normally seen between the connect- 
ive tissue fibres are supposed to be lymphatic spaces; they 
have no proper boundaries. The blood-vessels and lym- 
phatics are thought to communicate, though this has not 
been proved, by means of peri- vascular spaces where the 
blood-vessels and lymphatics run together, the walls of 
these spaces being formed by the connective tissue around. 



'K 



THE ANATOMY OF THE SKIN. 17 

Nerves accompany the blood-vessels coming up from 
below, and are of two kinds, medullated and non-meduU- 
ated; the former go with the tactile and Pacinian cor- 
puscles, and the latter form, it is thought, a fine netw^ork 
below^ the site, in connection with the capillary plexus, 
and are in communication with those found in the site. 
Non-meduUated fibres also run with the capillaries, which 
supply the vascular papillae. 

The subcutaneous cellular tissue is nothing but a lax 
network of connective tissue. The bundles of fibres, 
"usually cylindrical, exhibit constrictions at various 
points like those of the arachnoid membrane, and consist 
of a number of sinuous fibres of connective tissue, be- 
tween w^hich lie numerous fusiform and connective-tissue 
corpuscles of various forms and dimensions. " It is this 
part in w^hich the fat cells are collected in the meshes of 
the fibres, the only seats destitute of fat being the eyelids, 
penis, scrotum, and ears. The fat I need not describe. 
The fusiform cells that lie between the bundles and fibres 
of the connective tissue are connected with these fibres 
by means of processes given off one at either end, with 
other minor ones elsewhere. Other fusiform cells, with- 
out processes (the migrating cells), and small cells like 
blood-cells, are observed, the latter being contiguous to 
the vessels. There is no line of demarcation between the 
corium above and the subcutaneous tissue below. 

The Sweat Glands. — A sweat-gland, hke other 
glands, consists of a secreting portion and a conducting 
portion. The secreting portion is a long tubulur alveolus 
coiled up in a knot and placed in the subcutaneous con- 
nective tissue at some distance from the epidermis. Gen- 
erally the gland is formed of one such tubule only, but 
sometimes two tubules unite into a common duct. The 
duct beginning in the knot, in the convolutions of which 



18 SKIN DISEASES. 

it shares, runs a somewhat wavy but otherwise straight 
course vertically toward the surface of the skin onto 
which its lumen opens. 

Through the epidermis the duct is nothing more than 
a tubular passage excavated out of the epidermis with a 
remarkable corkscrew course, the turns of the screw be- 
coming more open and the canal wider in the upper part 
as it approaches the surface. In the Malpighian layer 
the cells bordering on the passage are flattened and in- 
clined downward so as to afford a more or less definite 
lining; there is a similar arrangement, but not so well 
seen, in the corneous layer. Reaching the dermis in a 
valley between papillae, the passage becomes a regular 
duct, with an independent epithelium of its own, a dis- 
tinct basement membrane continuous with the upper sur- 
face of the dermis, and an outer coat of connective tissue 
strengthened, in the case of some of the larger glands, 
such as those of the axilla, with plain muscular fibres. 
The epithelium consists of two or three layers of small 
rounded cells, each with a relatively large but absolutely 
small nucleus, generally staining deeply. The cells leave 
a narrow tubular thread-like lumen which is lined with a 
very characteristic distinct cuticle. 

The duct continues to possess these characters after it 
has entered the knot and begun to pursue a twisted 
course, but soon changes suddenly into the secreting 
tubule. This may be distinguished from the duct by 
being wider, and by being lined by a single layer of cubi- 
cal or columnar cells larger than those of the duct, bear- 
ing larger nuclei, and behaving differently toward various 
staining reagents. The lumen though fairly distinct is 
not lined by any cuticle as in the duct. Lying between 
the basement membrane and the epithelial cells, or rather 
imbedded in the basement membrane, are seen a number 



THE ANATOMY OF THE SKIN. 19 

of plain muscular fibres disposed longitudinall}^ or in an 
elongated spiral, and often forming a distinct coat beneath 
the epithelium. 

As in the case of other glands, we are unable to make 
any statement as to the work carried on by the epithelium 
lining the duct, but we may probably assume that the 
sweat is mainly secreted by the larger cells of the terminal 
coiled part of the tubule. These cells, therefore, like 
other secreting cells, are probably "loaded" and "dis- 
charged;" but as yet no structural changes in the cells 
corresponding to these phases have been satisfactorily as- 
ceHained, though after the administration of pilocarpine, 
w^hich causes sweating, the cells of glands hardened in 
alcohol stain more deeply than usual with carmine. It 
must be remembered, however, that the sweat contains 
normally neither mucus nor proteid substances, and we 
should, therefore, not expect to observe granules in the 
cells. 

The peculiarly placed muscular fibres have been sup- 
posed, by their contraction, to assist in the flow of sweat 
along the tubule. In certain cutaneous glands of the 
frog, of a relatively simple nature, there is evidence that 
the secretion is ejected from the comparatively large 
lumen by the contraction of plain muscular fibres in the 
wall of the gland, or by a contraction of the wall itself, 
which is contractile without being distinctly differentiated 
into muscular tissue. And this rather supports the 
above view; but the matter is at present by no means 
clear. 

The coil of a sweat gland is well supplied with blood- 
vessels in the form of capillary networks, and nerves have 
been traced to the tubes; but the exact manner in which 
these end is not as 3^et known. 

Though present in all regions of the skin (of man), 



20 SKIN DISEASES. 

the sweat glands are unequally distributed, being more 
abundant in some regions, such as the palms of the hand, 
than in others. In the axilla are glands of very large size, 
and in these the ducts possess distinctly muscular coats. 

The sebaceous glands are appendages of the hairs, and 
are seated in the corium; their ducts open into the hair 
follicle at the neck in the case of the larger hair follicles; 
but in the case of the smaller, or downy hairs, the relative 
position of the glands and hair follicle is altered, so that 
the minute hair follicle leads into the duct of the seba- 
ceous gland, which opens directly on the surface. These 
glands are absent from the palm of the hand, the sole of 
the foot, and the dorsum of the third phalanges of the 
fingers and toes, and there are few about the penis. The 
largest are found about the nose, scrotum, anus, and 
labia. 

Just where the corneous layer abruptly leaves off in the 
upper part of the hair follicle, a sebaceous gland opens 
into the cavity of the follicle, on each side of the hair. 
Each gland consists of a short rather wide duct which 
divides into a cluster of somewhat flask-shaped alveoli. 
The basement membrane, both in the alveoli and in the 
duct, is lined with a layer of rather small cubical cells 
continuous with the layer of perpendicularly disposed 
cells which form the innermost layer of the outer root- 
sheath, as of the Malpighian layer of the skin generally. 
This layer of cells leaves a wide lumen both in the alveoli 
and in the duct; this lumen, however, is occupied not as 
in other glands with fluid, but with cells. Both alveoli 
and duct, in fact, are filled with rounded or polygonal 
cells which may be regarded as modified cells of the Mal- 
pighian layer. The whole gland, indeed, is a solid 
diverticulum of the Malpighian layer. 

In the alveoli the cells next to the layer of cells imme- 



THE ANATOMY OF THE SKIN. 21 

diately lining the basement membrane, though larger 
than these, resemble them in so far that each consists of 
ordinary cell substance surrounding a nucleus of ordinary 
character. The more central cells are different; their cell 
substance is undergoing change; numerous granules or 
droplets, some of them obviously of a fatty nature, make 
their appearance in them, and the nuclei are becoming 
shrunk and altered. The cells are manufacturing fatty 
and other bodies and depositing the products in their own 
substance, which, however, is not being removed, but is 
dying. These changes are still more obvious in the cells 
lying within the duct; the cells as indicated by the break- 
ing up of the nuclei are dead, and the whole of the cell 
substance has been transformed into the material consti- 
tuting the secretion of the gland called sebum, which is 
discharged on to the surface of the skin through the 
mouth of the hair follicle. 

In these sebaceous glands, secretion, if we may con- 
tinue to use the word, takes place after a fashion different 
from that which we have hitherto studied. In an ordinary 
gland the cells lining the walls of the alveoli manufacture 
material which they discharge from themselves into the 
lumen to form the secretion, their own substance being at 
the same time renewed, so that the same cell may con- 
tinue to manufacture and discharge the secretion for a 
very prolonged period without being itself destroyed. In 
a sebaceous gland the work of the cells immediately lin- 
ing the wall of an alveolus appears limited to the task of 
increasing by multiplication. Of the new cells thus 
formed, while some remain to continue the lining and to 
carry on the work of their predecessors, the rest thrust 
toward the centre of the alveolus are bodily transformed 
into the material of the secretion, and during the trans- 
formation are pushed out through the duct by the genera- 



22 SKIN DISEASES. 

tion of new cells behind them. The secretion of sebum, 
in fact, is a modification of the particular kind of secre- 
tion taking place all over the skin, and spoken of as shed- 
ding of the skin. It is chiefly the chemical transforma- 
tion which is different in the two cases. In the skin 
generally the protoplasmic cell substance of the Malpig- 
hian cells is transformed into keratin; in the sebaceous 
glands it is transformed into the fatty and other constitu- 
ents of the sebum. 

The so-called ' ' ceruminous glands ' ' of the external 
meatus of the ear are essentially sweat glands. They 
are wrongly named, since the fatty material spoken of as 
* ' wax ' ' of the ear is secreted not bj^ them but by the 
sebaceous glands belonging to the hairs of the meatus, or 
by the general epidermic lining. The ceruminous glands 
appear at most to supply the pigment which colors the 
''wax." 

The Meibomian glands of the eyelids, on the other 
hand, are essentially the sebaceous glands of the eye- 
lashes, the glands of Mohl being in turn sweat-glands. 

A hair is a development, in the form of a c) Under, of a 
cap of corneous epidermis surmounting a papilla of the 
dermis sunk to the bottom of a tubular pit, or involution 
of the skin, called a hair-follicle. In the upper part of 
the hair-follicle the walls consist of ordinary skin with 
all its parts, dermis, Malpighian layer, and corneous 
layer, the latter as usual of considerable thickness. At 
some little distance from the mouth of the follicle the 
corneous layer suddenly ceases, and in the follicle below 
this the epidermis is represented by the Malpighian layer, 
now called the outer root-sheath, and two layers of pecu- 
liar cells, forming the inner root-sheath, of which the 
outer is called Henle's and the inner Huxley's layer; 
these may, perhaps, be considered as corresponding to 



THE ANATOMY OF THE SKIN. 23 

the stratum granulosum lucidum respectively. The 
dermis of the wall of the follicle is at the same time de- 
veloped into an outer layer with bundles of connective 
tissue disposed chiefly longitudinally, and an inner layer 
of peculiar nature, the arrangement of which is trans- 
verse, and which at least simulates, if it really be not, a 
muscular transverse coat. Betw^een this dermis of the 
follicle and the outer root- sheath or Malpighian layer is a 
very conspicuous definite hyaline basement membrane, so 
thick that it presents a very easily recognized double 
contour. 

At the bottom of the follicle the dermis of the wall of 
the follicle is continuous with the substance of the 
(dermic) papilla, while the outer root-sheath or Mal- 
pighian layer, which here becomes extremely thin and re- 
duced to one or two layers, is reflected over the papilla, 
and there expands again into a mass of cells, which like 
the cells of the Malpighian la57er in the rest of the skin 
multiply, and by their multiplication give rise to the 
corneous body of the hair. It is said that in those hairs 
which possess a medulla the vertically disposed lower- 
most cells of the Malpighian layer are at the actual sum- 
mit of the papilla continued upward in the axis of the 
hair, as the medulla. 

The layer of Henle, following the Malpighian layer or 
outer root-sheath on which it rests, is similarly reflected 
and forms over the hair a single layer of flat transparent 
imbricated scales known as the cuticle of the hair; Hux- 
ley's layer, similarly reflected, forms a similar layer of 
similar scales, but this is considered as belonging to the 
root-sheath, and is called the cuticle of the root-sheath. 

Muscles of the skin : There appear to be two kinds of 
muscles found in the skin — the voluntary, or striated, 
and the involuntary. The former are to be detected in the 



24 SKIN DISEASES. 

face, beard, and nose, "ascending sometimes obliquely, 
sometimes vertically, between the hairs and the sebaceous 
follicles to terminate in the corium " (Biesiadecki). 
They come from below. The organic or non-striated 
muscles are more abundant. They occur forming a kind 
of network in the scrotum. Over the general surface of the 
skin bands of fibres are detected in connection with the 
hair follicle, and are called arredores pili. These muscles 
exist as single fasciculi .045 to .22 of a millimetre, some- 
times on one, sometimes on both sides of the hair follicle, 
in immediate relation to the sebaceous glands, which they 
enclose more or less. They run from the corium above 
to the part of the hair follicle just below the glands, and 
there end in the inner sheath of the hair follicle. Some 
authors affirm that bundles go down to the subcutaneous 
tissue and send off vertical and horizontal branches. 
Neuman, who is of this opinion, states that bands run 
above and under the sweat glands, more especially in the 
axilla. He describes also independent bundles of muscle 
in the corium quite unconnected with the hair follicles. 

The nails, and the part upon which they lie, are essen- 
tially the same in structure as the skin in its different 
parts, only that the horny layer is more developed, form- 
ing the actual nail. Posteriorly, the nail is fitted into a 
groove; the part fitting into the recess is called the root, 
and the portion underlying the nail is that which repre- 
sents the corium — it is, in fact, the corium; it bears, how- 
ever, the name of matrix. Between the nail itself and 
the matrix is the rete mucosum ; in fact, the bed of the 
nail may be described as consisting of corium with the 
sub-connective tissue beneath, and the rete above. 

As in the case of the skin the rete dips down between 
the papillary projections of the corium of the nail. 

The corium itself, or matrix, is divided into two parts. 



{■■■■■■■■■■■fii 



THE ANATOMY OF THE SKIN. 25 

which are separated by a more or less convex line seen 
through the nail and known as the lunula. The hinder- 
most of these two divisions has its papillae directed 
forward, less distinct, and more closel}^ seated together. 
The front portion is thrown into longitudinal folds, and 
upon these are seated the papillae. These folds are pro- 
duced by the peculiar disposition of bundles of connective 
tissue in the structures beneath. The matrix towards 
the front part of the nail is covered by cells that are more 
and more horny, whereas over the posterior surface of 
the matrix (the root of the nail) these cells are softer. 
In fact, the part of the nail matrix behind the lunula is 
the spot where the nail is formed. The soft cells are di- 
rected forward, guided by the fold of the skin over the 
nail at its root — which fold lacks glands, and papillae on 
the surface applied to the nail — becoming more horny as 
they advance. 

A correct knowledge of the anatomy of the skin is an 
immense aid to the right comprehension of morbid changes 
going on in the skin. 

The epithelial stratum of the skin, made up of the 
horny and mucous (rete Malpighii) layers, are the special 
seat of a number of morbid processes. In parenchy- 
matous inflammation as in small-pox, the first stage seems 
to be a great increase in the cells of the rete, and the 
pustule subsequently produced is formed bodily in the 
rete, its walls being formed by altered rete cells, stretched 
into fibres and enclosing pus cells. In the formation of 
vesicles and bullae, the rete is chiefly concerned. In 
some cases of non-inflammatory diseases, the epidermic 
cells are found to have undergone special changes, or to 
have been arrested in their development, as in psoriasis. 

The relation of the epidermis to the papillary layer, in 



26 SKIN DISEASES. 

regard to diseased action, is a matter of no little import- 
ance. 

' Dr. Auspitz draws the following conclusions in re- 
gard to the production of diseases from the growth in- 
wards of and resultant changes in the papillary layer: 

1. In hyperseraic and inflammatory processes occurring 
in the skin the papillae are found to be only succulent and 
slightly swollen ; but no modifications of form occur, un- 
less consecutive to secondary change in the Malpighian 
stratum. 

2. In simple and lymphatic hypertrophy of the con- 
nective tissue matrix, as well as in cell-infiltrations of the 
corium, the same law holds 

3. In the keratoses, or horn-producing affections — 
ichthyosis — there is either no change in the form or size 
of the papillae, or it is due only to the pressure of the 
hypertrophied horny layer. The prismatic and columnar 
forms of the latter are by no means dependent on the 
papillae of the cutis. 

4. The papillomata (warts, condylomata, epithelioma) 
originate essentially in an active neoplastic process taking 
place in the rete, which penetrates to a greater or less ex- 
tent into the likewise hypertrophied connective tissue 
matrix of the corium. The papillae of the cutis, here, 
too, perform only a passive role, their elongation and 
dentritic form being occasioned by the hypertrophy of 
the epidermis; whilst the elevation of the surface of the 
skin is due to the hypertrophy of both. 

5. An outgrowth of the connective tissue of the skin 
sometimes occurs, but is never dependent on the pre- 
existent papillae. 

6. There is no essential anatomical difference between 
the several forms of papillomata, warts, pointed condyl- 
omata, and cauliform excrescences. The syphilitic con- 



THE ANATOMY OF THE SKIN. 27 

dyloma differs from these oul}- through the specific cell 
infiltration of the coriiim. 

7. Epithelioma represents exquisitely the types of the 
hypertrophic growth inwards of the epidermis into the 
connective tissue matrix. 

The rete is an important pathological ground, from the 
fact that in most inflammatory processes there is to be 
found in it a great increase of the spindle-shaped or 
migrating corpuscles. It is now established that cutane- 
ous cancers originate in a morbid change in the cells of 
the Malpighian layer, and by the disordered growth of 
these same cells in masses from their inter-papillary 
parts, into the corium. This is an undoubted fact and 
gives countenance to Dr. Auspitz's views. 

The corium is also the seat of very important patho- 
logical changes that originate in its substance and various 
alterations of its component elements It is the essential 
seat, of course, of hypersemic changes; and according as 
the longitudinal plexus, or the papillary vascular loops, 
or both, are implicated the redness varies in aspect. The 
corium is, further, especially its papillary layer, the early 
seat of many inflammatory changes, the vessels dilating, 
and permitting moreover the escape of white blood cells 
into the corial textures, and likewise serum, which makes 
its way to the rete, forming vesicles, etc. Then, again, 
the fibrous elements of the corium furnish the migrating or 
fusiform cells that appear in great numbers in chronic in- 
flammations especially, and migrate to the rete. The 
corium is the chief seat, moreover, of neoplasmata other 
than cancerous, as in the case of syphilis and leprosy; 
these new growths supposedl}^ originating from the con- 
nective tissue elements. A simple increase of the latter, 
too, is held to constitute certain other diseases, such as 
pachyderma, keloid, etc. The vacuolae and lymphatic 



28 SKIN DISEASES. 

Spaces are also seats of particular changes, as in lepros}'. 
A knowledge of the structure and peculiarities of hair 
follicles and sebaceous glands is not less important in re- 
lation to the origin of many common diseases, as acne, 
fibroma, cancer, lichen planus. Without it the student 
will attain little real knowledge of the pathology and 
therapeutics of these frequently occurring affections. 

In the case of the nail, unless a student knew what was 
the part of the matrix at which the nail was actually 
formed, he would be at a loss to diagnose a syphilitic from 
a non-syphilitic growth, or to comprehend the difference 
which arises when inflammation attacks now the posterior 
part of the matrix (where the nail is formed), or now the 
anterior portion; nor would he be able to explain the pre- 
dilection of parasites for the root of the nail. 

The Nature and Amount of Perspiration. 

The quantity of matter which leaves the human body 
by way of the skin is very considerable. Thus it has 
been estimated that while 0.5 gramme passes away 
through the lungs per minute, as much as 0.8 gramme 
passes through the skin. The amount, however, varies 
extremely; it has been calculated, from data gained by 
enclosing the arm in a caoutchouc bag, that the total 
amount of perspiration from the whole body in twenty- 
four hours might range from 2 to 20 kilos; but such a 
mode of calculation is obviously open to many sources of 
error. 

Of the whole amount thus discharged part passes away 
at once as watery vapor mixed with volatile matters, 
while part may remain for a time as a fluid on the skin; 
the former is frequently spoken of as insensible, the latter 
as sensible, perspiration or sweat. The proportion of the 
insensible to the sensible perspiration will depend on the 



THE NATURE AND AMOUNT OF PERSPIRATION. 29 

rapidit}^ of the secretion in reference to the dryness, tem- 
perature, and amount of movement of the surrounding 
atmosphere. Thus, supposing the rate of secretion to 
remain constant, the drier and hotter the air, and the 
more rapidly the strata of air in contact with the body 
are renewed, the greater is the amount of sensible per- 
spiration which is b}^ evaporation converted into the in- 
sensible condition; and conversely when the air is cool, 
moist, and stagnant, a large amount of the total perspira- 
tion may remain on the skin as sensible sweat. Since, as 
the name implies, we are ourselves aware of the sensible 
perspiration only, it may and frequently does happen that 
we seem to ourselves to be perspiring largely, when in 
reality it is not so much the total perspiration which is 
being increased as the relative proportion of the sensible 
perspiration. The rate of secretion may, however, be so 
much increased that no amount of dryness or heat, or 
movement of the atmosphere, is sufficient to carry out the 
necessary evaporation, and thus the sensible perspiration 
may become abundant in a hot, dry air. And practically 
this is the usual occurrence, since certainly a high tem- 
perature conduces, as we shall point out presently, to an 
increase of the secretion, and it is possible that mere dry- 
ness of the air has a similar effect. 

The amount of perspiration given off is affected not 
only by the condition of the atmosphere, but also by the 
circumstances of the body. Thus it is influenced by the 
nature and quantity of food eaten, by the amount of 
fluid drunk, by the character of exercise taken, by the 
relative activity of the other excreting organs, more par- 
ticularly of the kidney, by mental conditions and the like. 
Variations may also be induced by drugs and by diseased 
conditions. How these various influences produce their 
effects we shall study shortly. 



30 SKIN DISEASES. 

The fluid perspiration, or sweat, when collected, is 
found to be a clear, colorless fluid of a distinctly salt 
taste, with a strong and distinctive odor, varying accord- 
ing to the part of the body from which it is taken. Besides 
accidental epidermic scales, it contains no structural 
elements. 

Sweat, as a whole, is furnished partly by the sweat 
glands and partly by the sebaceous glands, for, as we 
shall see, the small amount which simply transudes 
through the epidermis, apart from the glands, may be 
neglected. Now, the secretions from these two kinds of 
glands differ widely in nature, and the characters of the 
sweat, as a whole, will vary according to the relative 
proportion of the two kinds of secretion. The secretion 
of the sebaceous glands appears to be fairly constant, the 
larger variations of the total sweat depending chiefly on 
the varying activity of the sweat glands. Hence, when 
sweat is scanty, the constituents of the sebum influence 
largely the character of the sweat; when, on the contrary, 
the sweat is very abundant, these may be disregarded, 
and the sweat may be considered as the product of the 
sweat glands. 

We are not able at present to make a complete state- 
ment as to what bodies occur exclusively in the sebum 
and what in the secretion of the sweat glands. The 
former consists very largely of fats and fatty acids, and 
appear to contain some form or forms of proteids; but we 
have reason to think that the sweat glands secrete in small 
quantity some forms of fat, and especially volatile fatty 
acids. 

When sweat is scanty, the reaction is generally acid, 
but when abundant, is alkaline; and when a portion of 
the skin is well washed the sweat which is collected im- 
mediately afterward is usually alkaline. From this we 



THE NATURE AND AMOUNT OF PERSPIRATION. 31 

may infer that the secretion of the sweat glands is natur- 
ally alkaline, but that when mixed sweat is acid; the 
acidity due to fatty (or other) acids of the sebum. In 
the horse, which is singular among hair covered animals 
for its frequent profuse sweating, the sweat is said to be 
always acid and to contain a considerable quantity of 
some form of proteid. These features are probably due 
to the large admixture of sebum from the numerous 
sebaceous glands connected with the hairs. 

Taking ordinary sweat, such as may be obtained by 
enclosing the arm in a bag, we may say that in man the 
average amount of solids is from i to 2 per cent., of 
which about two-thirds consist of organic substances. 
The chief normal constituents are: (1) Sodium chloride, 
with small quantities of other inorganic salts. (2) Vari- 
ous acids of the fatty series, such as formic, acetic, butyric, 
with probably propionic, caproic, and caprylic. The pres- 
ence of these latter is inferred from the odor; it is probable 
that many various volatile acids are present in small quan- 
tities. Lactic acid, which has been reckoned as a normal 
constituent, is stated not to be present in health. (3) 
Neutral fats and cholesterin; these have been detected 
even in places such as the palm of the hand, where 
sebaceous glands are present. (4) The evidence goes to 
show that neither urea nor any ammonia compound exists 
in the normal secretion to any extent, though some ob- 
servers have found a considerable quantity of urea (cal- 
culated at ten grms. in the twenty-four hours for the 
whole body). Apparently some small amount of nitro- 
gen leaves the body or the skin, as a whole, but this is 
probably supplied by the sebum or by the epidermis. 

In various forms of disease the sweat has been found to 
contain, sometimes in considerable quantities, blood, albu- 
min, urea (particularly in cholera), uric acid, calcium ox- 



32 SKIN DISEASES. 

alate, sugar (in diabetic patients), lactic acid, indigo (or 
indigo-yielding bodies giving rise to " blue " sweat), bile, 
and other pigments. Iodine and potassium iodide, suc- 
cinic, tartaric, and benzoic (partly as hippuric) acids have 
been found in the sweat when taken internally as medi- 
cines. 



CHAPTER IL 



SOME GENERAL OBSERVATIONS. 

The great number of diseases peculiar to the skin 
which present themselves for treatment are well worthy 
of the most earnest and anxious consideration of the gen- 
eral practitioner as well as of the specialist. It is only 
of recent years that the varieties of skin diseases have 
been made a special subject of study by numerous phy- 
sicians in this country and abroad, and we may point 
with pride to the rapid strides made as regards the 
pathology, diagnosis, prognosis and treatment of these 
formerly obscure and obstinate diseases. 

Correct diagnosis of cutaneous affections is the founda- 
tion of successful therapeutics; but diagnosis, properly 
speaking, does not alone consist in giving the correct or 
approved name to the disease immediately under consid- 
eration, nor even in a careful differentiation of the special 
variety. It involves a broader knowledge, including a 
more or less complete acquaintance with the nature and 
relationships of the various affections. The mere naming 
of a disease is a comparatively easy matter, and of greatl}^ 
inferior value to that more comprehensive knowledge that 
appreciates that the disease is not a distinct entity by 
itself, but is rather the result of a particular or peculiar 
pathological process in progress in a person with a given 
constitution or habit of body. 

In these days patients want to know what disease they 
are affected with, and, in the great majority of cases, 



34 SKIN DISEASES. 

they will read up for themselves all that they can find 
upon the subject. The term eruption will not answer for 
the more intelligent. The intelligent physician must not 
be content with being able to simply give the systematic 
name that is applied to the particular lesion or group of 
lesions present, but should also be able to make a diag- 
nosis of the patient as well. 

Of late years dermatology has divided the different 
eruptions into classes and sub-classes, and with this di- 
vision a more thorough and extended study of the causes 
pathology and treatment of the same has been accom- 
plished, and the dermatologist can intelligently study the 
various lesions of the skin and form a correct opinion as 
to the duration, progress and ultimate result in each and 
every case. 

A man says he has an eruption upon the face, and wants 
to know what it is and when he will get over it. His re- 
mark that he has an eruption conveys to the mind about as 
much of an idea of the trouble as if he said he had a hole 
in his coat. We must know, before we can express an 
opinion, what kind of an eruption it is. Is it vesicular, 
papular, pustular or tubercular ? When we find that it is 
vesicular, we then wish to know the size of the vesicles, 
whether they burst or not, whether they itch or not and 
a number of other points which help us to arrive at a 
correct understanding of his case. We are then able to 
tell what the affection is, and its probable duration and 
ultimate termination. We are enabled, also, to give him 
the proper medicines, prescribe a suitable diet, and to take 
such measures as will protect others against the disease, 
if it is of a contagious nature. Errors in diet predispose 
to certain affections of the skin, and in very many cases 
aggravate existing disorders. Want of cleanliness is a 
frequent cause of cutaneous eruptions, as well as of many 



SOME GENERAL OBSERVATIONS. 35 

of the preventable diseases. So, also, is the abuse, or 
even use, of alcoholic stimulants, cosmetics, tobacco, etc. 
A man's occupation is sometimes to blame for his un- 
healthy skin; especially is this true of the baker, the 
grocer, the mason, the bricklayer, the painter, the pho- 
tographer, etc. Frequently the medicines taken for some 
internal disease cause an eruption, the nature and cause 
of which is not always seen at a first glance and may be 
entirely overlooked. Belladonna, Carbolic acid ^ Iodide of 
Potash, Sulphzi?^, lodofoj^^n, Antipyrine and a great many 
other remedies produce eruptions. Mental shock and 
emotions also produce eruptions. 

The following cases of Dermatoses following mental 
shock were reported in our journals in 1889: 

A lady, after witnessing a violent assault upon her hus- 
band, was much prostrated by the fright, and three weeks 
later a bullous eruption, having the characteristics of 
foliaceous pemphigus and accompanied by incessant pru- 
ritus, made its appearance. 

Another case was a little girl who was rescued from 
burning, and remained for some time in a condition of 
prostration from fright. x\ month afterward a pemphi- 
goid eruption made its appearance upon the body, disap- 
peared under treatment, but reappeared several times. 

A third case was that of a w^oman who became very 
much excited in a quarrel with her husband. A few days 
afterward an exudative erythema made its appearance on 
the arms, hands and feet; and vesicles on the lips. K. 
de Smet has recorded cases of purpura hsemorrhagica from 
the same cause. 

The dermatologist must be very observing and a good 
cross-examiner in order that he may see all that is upon 
the surface of the body, and by his critical examination 
draw out all that is below the skin in the shape of ab- 



36 SKIN DISEASES. 

normal sensations and symptoms. The more complete 
and thorough the description he obtains from the patient, 
the more accurate is his diagnosis apt to be, and the more 
successful his treatment; for the same affection in two 
patients may require almost opposite treatment. Take 
shingles, for example. The eruption may be precisely 
the same in two children, but the accompanying pains in 
one are burning, jerking and itching, worse in the even- 
ing, and from the slightest touch; in the other, burning, 
neuralgic pains, worse about midnight, but ameliorated 
by warmth. The first case will be relieved by Zinc, the 
second by Arsenicum. Or, we may illustrate by two 
cases of acne occurring in a brother and sister. The one 
patient addicted to sexual excesses and strong drink, 
with a tired feeling all the time; the other, suffering with 
scanty menses, gastric difficulties and frequent diarrhoea. 
The disease is the same in both persons, but the causes 
are different, and we should be obliged to give Rhus in 
the first case, and Ptds. in the other. Again, an eczema 
in one may be the expression of ill-nutrition from pri- 
vation or scanty supply of proper food, while in an- 
other it may be the result of a plethora due to excessive 
indulgence in the pleasures of the table. We may, it is 
true, apply the name eczema in both instances, on account 
of the similarity of the lesions; yet the real condition of 
the two patients is almost diametrically opposite. 

A positive diagnosis, it should be remembered, is not 
always possible upon a first examination, but it is desir- 
able at all times that we may distinguish between a con- 
tagious and a non-contagious affection. For example, how 
important it is to recognize herpes of the prepuce, and 
not mistake it for chancre. The one, a disease of but lit- 
tle importance, the other of the greatest significance; in 
fact, *a terrible infliction, which, if wrongly diagnosed, 



SOME GENERAL OBSERVATIONS. 37 

may lead to the infection of perhaps dozens of others, 
and among the number many perfectly innocent persons. 
This statement may seem rather strong, but instances are 
on record where several persons have become infected 
from using the common water-closet. And yet, these two 
diseases, herpes of the prepuce and chancre, are fre- 
quently confounded, but, fortunately for the welfare of 
the community, it is usually the innocent one that is 
mistaken for the more serious. 

The prognosis is not as important, perhaps, as the 
diagnosis, considering the fact that very few skin diseases 
are destructive to life, but it is a great comfort to the 
patient to learn that the disease is one of no danger; that 
it is not contagious, and that, in a short time, it will be 
cured. When the patient has good reasons to suspect 
that the eruption upon the skin is only a manifestation of 
some form of syphilis, no words can convey the feeling 
of relief experienced when he or she is told that the 
trouble is only a skin disease and in no way connected 
with that loathsome disorder. 

The causation is always to be carefully investigated and 
studied, for by removing the special causes in each case a 
return to health may be expected, or at least the patient 
is put in the best possible condition for recovery. All 
violations of the general laws of health may produce dis- 
eases of the skin, hence it is very important to inquire 
into the habits, occupation, diet and dwelling-places of 
those seeking treatment. 

The treatment of skin diseases varies, of course not 
only in different affections, but in the same disease as it 
occurs in persons of different diathetic tendencies. Each 
patient must be treated according to the special indica- 
tions in his case. We must consider his age, his sur- 
roundings, his diet and mode of life, and all co-existing 



38 SKIN DISEASES. 

diseases which aggravate or are the cause of his trouble. 
In short, treat the totahty of symptoms. 

The majority of cases of diseases of the skin are not 
preceded or even accompanied by severe constitutional 
disturbances; if there happen to be much fever and 
malaise, especially when the patient takes to bed from a 
sheer feeling of illness, and an eruption rapidly develops 
itself, something grave, probably one of the acute specific 
diseases, is present. This is all the more likely to be the 
case if the patient falls, at it were, suddenly ill. The main 
guide in these cases is the temperature: if the ther- 
mometer be raised in the axilla to loi or 102 degrees F., 
and emphatically so if to a higher point than this, there 
can be very little doubt on the point. However, amongst 
the occasional exceptions, acute lichen, erythema no- 
dosum, secondary syphilis, acute eczema, pityriasis rubra, 
acute pemphigus, urticaria, zoster, may be named, but 
these are not accompanied by high temperature. Sec- 
ondary syphilis has been mistaken for the mottling of 
typhus and measles, acute lichen for measles, and zoster 
for pleurisy, on account of the pain. Occasionally in 
eczema there may be marked pyrexia, but not a markedly 
high temperature. When symmetrical, the disease is 
usually due to a blood-poison; when unsymmetrical, to 
local causes or perhaps to affections of the nervous 
trunks. 

Perhaps one of the greatest errors committed in diag- 
nosing cutaneous diseases is the dealing with them in a 
piecemeal manner. It is the universal expectation of the 
student to be able to diagnose a disease of the skin from 
merely looking at it. Many a student, if asked with a 
patient before him. What is that disease? will look, — 
and, it may be, look closely — and then make his diag- 
nosis and give the thing a name. In no other class of 



SOME GENERAL OBSERVATIONS. 39 

disease would he do that. He would obtain the objective, 
and the subjective symptoms; and use every means at his 
command for ph3^sical examination. It is of equal im- 
portance that he exhibit a like careful comparison in 
lesions of the skin. 

One of the first cares of the dermatologist should be to 
distinguish in diagnosis between primary and secondary 
phenomena. The one set are of course essential points of 
the disease, and the secondary results may, if care be not 
taken, be elevated to the rank of important items. For 
instance: In the case of an erythema, in connection with 
long-continued congestion, more or less thickening may 
occur; if this be not clearl}^ perceived to be an accidental 
occurrence, the diagnosis becomes difficult. Take the 
case of pityriasis rubra, a disease in which the whole 
skin becomes intensely hyperaemic with free shedding of 
scales. If this be properl}'' treated it will disappear, and 
leave not a trace. It may be unaccompanied throughout 
its course by anj^ thickening of the papillar}'- layer; but 
if it continues a long while this la5^er may be thickened, 
and then .there are present hyperaemia, papillary h5^per- 
trophy, and scaliness, as in psoriasis; and the diagnosis 
between pityriasis rubra and psoriasis could not be made 
from the mere surface appearances and alterations only. 
But the two things clinically are wholly different. This 
shows the importance of attending to the primary ele- 
mentary lesion and the historj^ and course of diseases. 

Again, in searching for the earliest stage of disease 
when that occurs in patches, it is necessary to go to the 
edge of the disease since it there presents its most recent 
characters. 

The typical course and characters of any disease may 
be masked by the co-existing development of a second 
disease, and here the interminglage of the features of the 



40 SKIN DISEASES. 

twain will be detected, as in urticaria and scabies or pur- 
pura; scabies and syphilis; eczema and scabies; eczema 
and psoriasis, and the like. The capriciousness as re- 
gards the appearance and disappearance of an eruption of 
an erythmatous type, is suspicious of urticaria. Multi- 
formity means that a disease is complicated, unless it be 
scabies or syphilis. 

As regards the temperament, the dermatologist is gen- 
erally enabled to say at a glance whether a patient is of 
full habit and likely to have a loaded system — especially 
the case in women; whether there be organic disease, or 
if there be a dyspeptic habit, or an ill-fed system, that 
signifies debility. If lymphatic, the patient is prone to 
eczema, impetigo, intertigo, the pustular aspect of scabies 
and ringworm; \i gouty, the scaly diseases, chronic eczema 
and lichen agrius; if rkeu?natic, erythema nodosum; if 
strumous, eczema, lupus; if florid, psoriasis especially. 
There is also the cancerous cachexia, and in nervous sub- 
jects various hyperesthesia engrafted upon ordinary erup- 
tions. Red-haired subjects are declared to be very liable 
to pityriasis of the scalp. 

Some eruptions are more or less periodic in their oc- 
currence, as in the case of pemphigus, but the derma- 
tologist should remember that in districts where malarious 
disease is common, a disease not usually possessing 
periodic features may sometimes be so influenced that its 
eruption occurs in a periodic manner, or the febrile dis- 
turbance by which it is accompanied may show itself in 
periodic outbursts. 

Psoriasis, eczema, and syphilitic diseases are essentially 
those which recur. 

Occupation exerts considerable influence in some 
lesions of the skin. Cooks are particularly liable to ec- 
zema and erythema, and bakers, grocers and bricklayers 



mmmgM 



SOME GENERAL OBSERVATIONS. 41 

to lichen about the backs of the hands; chimney-sweepers 
are liable to epithelioma of the scrotum; cotton- workers 
to urticaria; butchers and graziers to whitlow, boils and 
malignant pustule and ecthyma; cavalrymen and shoe- 
makers to eczema marginatum in the fork of the thighs; 
young women who come from the country and have the 
full diet fare of the city servants and those who change 
their mode of life, so that it entails more exercise and 
better living, get an overloaded system that shows itself 
in erythema papulatum, erythema nodosum, or impetigo. 

The age of the patient is very important. During the 
first six weeks of life congenital syphilis develops itself; 
intertrigo, eczema of the scalp, and seborrhoea capillitii 
also occur about the same time. Syphilitic pemphigus 
occurs, it is said, before the child is six months old, not 
afterwards; during the first few months and up to and 
through the period of dentition, strophulus and eczema 
are met with. Cancer (epithelioma) is a disease of late 
life — it does not occur before thirty, generally about sixty 
and bej^ond. Lupus is a disease which commences in 
early and j^oung life, and the same may be said of syphilis. 
The parasitic diseases occur in the young, rarely after 
twenty-one years of age. Herpes circinatus is the form 
seen in adult life. In old people, phthiriasis, ecthyma 
cachecticum, pemphigus, and pruritus, with cancer and 
rodent ulcer, frequently occur. 

We should have some rules as to the mode of studying 
skin diseases. The following are probably the best; they 
are taken from Fox: 

I . The observer should always strip his patient so that 
the disease may be exposed to the fullest extent compati- 
ble with a due regard to the proper feelings and sensitive- 
ness of the individual. To be satisfied with seeing a bit 
of a patch of disease in this spot, or just a spot or two 
4 



42 SKIN DISEASES. 

there where the malady is most marked even, is often to 
run great risk of arriving at an erroneous diagnosis, if not 
to actually make one, certainly to miss the recognition of 
transitional stages, which are of the utmost importance 
in determining the general character and often the exact 
nature of a disease. 

2. It is of much importance that mere stages of diseases 
should be regarded as stages and nothing else. Diseases 
must be dealt with in their entireties. Where the whole 
of a disease is made up in any particular instance of cer- 
tain stages, in estimating the nature and characteristics of 
that disease one stage must not be regarded in particular — 
be thrust into undue prominence — at the expense of 
others. The several stages together constitute the dis- 
ease. 

3. A clear distinction should be drawn between essen- 
tials and accidentals. For instance, the essence of scabies 
is the acarus in its furrow. All else that follow — the fol- 
licular irritation, improperly called lichen, the ecthyma, 
the urticaria, which may occur in many different dis- 
eased states of the skin — is accidental, and due to the irri- 
tation and the scratching practiced. 

4. It should be a point with the dermatological student 
to make as little as possible of mere superficial appear- 
ances and changes, because these are brought about as 
the result of, and are indeed often secondary to, more im- 
portant and primary changes in the deeper parts. 

5. It is important to pay special attention, as far as possi- 
ble, to the primary anatomical seat of the disease. What 
the primary seats of individual diseases are, so far as re- 
gards cutis, cuticle, follicles, and the like, I shall discuss 
in another place in speaking of elementary lesions and 
the individual diseases themselves. 

6. Special attention should be paid to the fact of the 



SOME GENERAL OBSERVATIONS. 43 

character of an eruption being permanejit, or transient^ 
or interchaiigeable. The case of lichen planus may be 
taken to illustrate this point. In it the characteristic 
lesion is a red flattened papule covered by the minutest 
scales. This is the sole lesion present. The papule 
never changes into a pustule or a vesicle; but not so is it 
with the papule of eczema or variola. The tendency of 
a syphilitic papule is to become oftentimes a pustule or 
tubercle, which gives place to an ulcer, and so on. The 
eruption as a whole may be again capricious, appearing 
and disappearing suddenly, often in the course of a few 
minutes. This feature in itself is almost diagnostic of 
urticaria. 

7. Those who are studying skin diseases should observe 
whether an eruption be uniform or 7nultiform in charac- 
ter. Multiformity implies (<z) the co-existence of two or 
more diseases, in which case there will be present the 
features of the two or more diseases commingled; or it im- 
plies {b~) the existence (i) if the lesions be inflamma- 
tory — that is, if pustules or vesicles be present, of scabies, 
or (2) if the lesions be degenerative, if ulcers and sup- 
purating tubercles, for example, be present, of syphilitic 
disease. The difference between the two main classes of 
cases, the complicated disease on the one hand and scabies 
and syphilitic on the other, being that in the former 
there are no transitional stages observed, as in purpura 
urticans, pemphigus pruriginosus, impetigo and scabies; 
syphilis and scabies, etc.; whereas, in the latter class, 
they are present as between the papules, vesicles, and 
pustules of scabies, or the papules, tubercles, pustules 
and ulcers of syphiloderma. Multiformity as it exists in 
scabies and syphilitic eruptions — relates in each case to 
such different kinds of eruption, and the multiformity 
moreover in complicated or co-existent diseases is seen to 



44 SKIN DISEASES. 

be due to the commingling of such distinct lesions with- 
out transitional forms that the character of multiformity 
becomes at once a very reliable guide in diagnosis; of 
course, other things help, as rest, development, etc., but 
multiformity is a good rough test of syphilis, scabies, or 
complicated diseases. 

8. It is wise to note certain differences, not only as to 
the general nature and character of cutaneous diseases as 
they exist in the old and young, but also in reference to 
the same disease as it occurs in the old and young. The 
cutaneous diseases of childhood are essentially distin- 
guished from those of the adult, in that they are uncom- 
plicated by organic diseases of the internal organs, and 
by those more complex and profound perversions of nu- 
trition which arise from overworked or badly used 
organs, such as gout, dyspepsia, free retention of excreta 
in the blood, rheumatism, and so on. They contrast with 
those in the old by the absence of coincident degenera- 
tive changes in the body, which are to be the lot of the 
man who passes the meridian of life. The cutaneous dis- 
eases of children are uncomplicated in this respect, and 
speaking generally, they are the result of the misuse of 
pabulum supplied to the body, or the direct consequence 
of improper diet. The case of eczema infantile may be 
taken as an example. But there is a difference in consti- 
tutional conditions — the diathetic conditions in the child 
who suffers from skin disease are different from those of 
the adult or aged. It does not take any long time to see 
how frequently the subjects of skin diseases in the young 
are strumous, and what an influence this diathesis has on 
the skin diseases of the young as contrasted with those 
of the middle-aged and of an age beyond the latter period 
of life; that syphilitic affections other than those heredi- 
tarily transmitted are specially the privilege of the adult, 



SOME GENERAL OBSERVATIONS. 45 

and so on; that in the advanced in years there are not 
only complicating organic diseases of internal organs, 
blood alterations due to mal-assimilation, degenerative 
tissue changes such as cancer, but disease specially con- 
nected with decay of the nervous system, as in senile pru- 
ritus. But to put what I wish to enforce in a few words, 
I may say that, as regards kiyid, the diseases of children 
are the result of malnutrition from deficient or bad feed- 
ing; those of the adult the result of mal-assimilation; 
those of the aged the result of degenerative changes. As 
regards complications, diseases of the young are often 
closely connected with the strumous diathesis especially; 
those of the adult with functional derangements of in- 
ternal organs and mal-assimilation, such as dyspepsia, 
hepatic and renal torpor — and with the diathetic condi- 
tions, phthisis, rheumatism, and the commencement of 
gout; those of the aged are linked with nerve pareses 
and degenerations of the skin, as evidenced by increased 
pigmentation, atrophy of the glands, and of the nerves 
in the papillae, and also with organic diseases of important 
internal organs. All this is important therapeuticall5^ 

9. It is to be remembered that there is a difference in 
the conditions associated with skin diseases, as they occur 
in hospital and private practice. The constitution of the 
hospital patient is depraved by mal- hygiene and want 
of proper food, that of the private patient is depraved, no 
doubt by want of hygiene oftentimes, but also by over- 
loading of the digestive organs, and not from actual want 
of food. But more than this; the nervous system partici- 
pates in the latter much more actively in helping, con- 
trolling, or modifying the existing disease; and this as 
the result of the luxury enjoyed by the rich, and the 
greater mental toil undergone by the busy man of the 
middle classes, the effects of which, in both cases, are felt 



46 SKIN DISEASES. 

by the offspring. The old amongst the hospital patients 
show especially nervous symptoms connected with physi- 
cal decay, and at the two extremes of life the evil con- 
sequences of uncleanliness are most marked, because 
there is less power to resist its influence — in the hospital 
patient. 

10. There are differences in the same disease as seen 
in this and other countries, as well as a distinction to be 
drawn between the several kinds of cutaneous affections 
occurring in this country and abroad. There is, indeed, a 
nationality of disease as well as of character or physique. 

11. A very close relation exists in many instances be- 
tween cutaneous disorders and functional disturbances in 
internal organs. Dr. Singer calls attention to this rela- 
tion, and thinks that it is more frequent than is generally 
known, as the symptoms, meteorism, flatulence, eructa- 
tions, loss of appetite, and constipation, may be lacking. 
Examination of the urine with detection of the greater or 
less excretion of indican will give one an index of how 
matters stand. Urticaria is nearly always accompanied 
by digestive disturbances. In the so-called idiopathic 
urticaria the amount of indican in the urine is nearly con- 
stantly increased. Collect the twenty-four hours' quantity 
and test from that as it varies during the day. He em- 
ployed Obermayer's reagent. In certain forms of facial 
acne, and in nearly all cases of senile pruritus, he found 
a constant relation between the skin eruption and in- 
creased intestinal fermentations at the lower portion of 
the small intestine. In some instances hyperaemic changes 
in the skin and mucous membrane have a common origin, 
as in lichen planus and pityriasis rubra, from disturbance 
of the sympathetic for example, and this is the explana- 
tion of the coincidence in the two diseases named, of the 
skin changes, and pyrosis, menorrhagia, and the like. In 



SOME GENERAL OBSERVATIONS. 47 

other instances the changes in skin and internal organs, 
instead of having a common origin, react the one upon 
the other, and the important point to notice is this: that 
the cutaneous troubles ma}^ be excited and intensified by 
internal troubles. There are four organs whose derange- 
ment excites or intensifies skin mischiefs. The stomach, 
the liver, the kidney, and uterus. In the vast majority 
of cases it is rather intensification than excitation that 
the practitioner has to deal with. 

12. It is important always to be aware of the fact of 
the bias impressed upon skin diseases by various dia- 
theses — especially the syphilitic, the gouty, the strumous, 
and the nervous. 

13. Observers should accustom themselves to examine 
microscopically the morbid products of skin diseases. 
The surgeon and the physician obtain most valuable indi- 
cations from the examination of the minutest portions of 
morbid tissue and the juice it may yield; and the derma- 
tologist is much to blame for an omission in this respect. 
The microscope affords very valuable assistance in the 
differential diagnosis of herpes, eczema, psorias'is, and 
tinea especially. For instance, inflammatory products 
are absent in psoriasis, present in the other three diseases; 
whilst in all forms of parasitic disease resembling herpes 
and eczema, as in so-called eczema marginatum, fungus 
elements are detected, provided proper care is observed. 



CHAPTER III. 



CLASSIFICATION OF THE ELEMENTARY 
LESIONS. 

The first step in diagnosis is to obtain a clear and full 
understanding of the different lesions, so that their true 
character may be recognized at a glance. Bach author 
has a pet classification which he honestly believes to be 
the best. One divides them into i. Maculae; 2. Erythe- 
matous; 3. Papular; 4. Vesicular; 5. Pustular; 6. Squam- 
ous; 7. Tubercular; 8. Parasitic. 

Another gives i. Masculae or stains; 2. Erythema or 
redness; 3. Wheals; 4. Papules, or pimples; 5. Squam- 
mse or scales; 6. Vesicles, or little bladders; 7. Blebs, or 
large vesicles; 8. Tubercula, or lumps; 9. Pustules, or 
mattery heads. 

I have found the following division to be of the greatest 
help in diagnosing skin affections: Macules, Vesicles, 
Bullae, Pustules, Papules, Tubercles, Scales, Fissures, 
and Ulcers. 

There is one remark I would make with a view of 
helping the reader to avoid a common error in regard to 
these lesions. It is this, that the different typical forms 
of lesions embrace or include each of them several varie- 
ties, and the designation of each typical form or lesion is 
to be regarded as a generic term, applicable to several 
varieties of the same lesion. It is not enough, for in- 
stance, to say a papule is present. Since there are various 



r 



CLASSIFICATION OF THE ELEMENTARY LESIONS. 49 

kinds of papules, it is necessary to state what particular 
kind of pustule is meant. When it is said a tubercle is 
present, the class to which the lesion belongs has only 
been defined; the tubercle may be that of a cancer, lupus, 
or syphilis. I am convinced that one of the commonest 
errors into which those who are studying skin diseases fall 
is the neglect to recognize the fact that there aix several 
different varieties of the same kind of elementary lesions, 
and their confusion of these several different varieties. 
This is especially the case with papules. We will de- 
scribe the several varieties of elementary lesions. 

A 7nacule is a small, circumscribed portion of skin, in 
which has occurred some alteration in its color, but with- 
out any secretion, effusion, infiltration, or change in its 
thickness or consistence. The macule itself may be w^hite 
from loss of pigment, red from congestion, or dark or 
black from increase of pigment. 

The principal diseases in which it occurs, and chief 
features, are: 

1. Chloasma, in which the macule or discoloration is 
somewhat diffuse, occurring on the forehead and cheeks, 
and is of a browmish color. 

2. Erythema; The macules are of varying size of a red- 
dish color. 

3. Ephelis; Macules of a yellowish to a dark brown 
color. Chiefly found on the exposed parts of the body. 

4. I^entigo; Small, dark-brown macules scattered over 
the surface, on the covered as well as on the uncovered 
portions. 

5. lycntigo maligna; Very dark macules, from the size 
of a large pin-head to that of a pea, later becoming in- 
filtrated, and sometimes ulcerating. 

6. lycprosy; Brownish macules of varying size. 



50 SKIN DISEASES. 

7. I^eucoderma; White or light-pinkish macules, sur- 
rounded by a dark border. 

8. Lupus; Minute reddish-brown or ham-colored. 

9. Nsevus; Red or purplish, disappearing on firm 
pressure. 

10. Purpura; Red or purplish, not disappearing on 
pressure. 

11. Rosacea; Rosy macules 

12. Syphilis; (a) Reddish macules, appearing in early 
syphilis, chiefly on the chest, abdomen and back; (b) 
Macules resembling those of leucoderma, and met with 
about the neck in young women in the early period of 
the disease. 

13. Xanthelasma; Yellowish macules, chiefly met with 
about the eyelids. A vesicle is a small elevation of the 
horny layer of the epidermis, by the effusion of a serous 
fluid. 

The principal diseases in which vesicles are found, and 
their chief features, are: 

1. Eczema; In patches, minute and closely aggregated, 
and rupturing in a day or two, except where the epi- 
dermis is very thick. 

2. Dermatitis multiformis; Lesions of larger size and 
greater duration, and frequently accompanied with other 
lesions of a pustular character. 

3. Erysipelas; Lesion situated on a diffused inflamed 
base, usually on the face. 

4. Erythema multiforme; Associated with macules and 
patches of erythema. 

5. Herpes; One or more groups of three or four vesicles 
of moderate size, and not packed together so closely as in 
eczema. They usually last a few days, and dry down into 
a small scale or crust, except on the genitals, where they 
rupture promptly. 



CLASSIFICATION OF THE ELEMENTARY LESIONS. 51 

6. Impetigo contagiosa; Medium-sized vesicles, lasting 
a few days and drying down to form crusts, occurring on 
any part of the body, 

7. Scabies; Small, pointed vesicles, usually met with 
on the hands and fingers. 

8. Sudamina; Minute, disseminated vesicles, corre- 
sponding to the sudoriparous ducts. 

9. Varicella; Vesicles of medium size, which may or 
may not be umbilicated. 

10. Variola; Umbilicated vesicles succeeding papules. 

11. Zoster; Vesicles of good size, seated on inflamed 
patches, and following the course of a nerve-trunk. 

A bulla is a larger elevation of the epidermis, by a 
serous or sero-fibrinous effusion, than a vesicle. 

The principal diseases in which bullae are found, and 
their chief features are: 

1. Erysipelas; The bullae of erysipelas are in reality 
very large vesicles, seated on the inflamed base. 

2. Leprosy; Large bullae, usually solitary, and appear- 
ing at intervals. 

3. Pemphigus; Large bullae, solitary, or in crops at in- 
tervals. 

A pustule is an elevation of the epidermis, small or 
large, by a purulent exudation. 

The principal diseases in which pustules are found, and 
their chief features are: 

1. Acne; Small, scattered pustules, resulting from the 
suppression of papules, chiefl}^ met with on the face, 
back, and chest. 

2. Ecthyma; Scattered pustules, of medium size. 

3. Eczema; Closely aggregated pustules, of small size. 

4. Dermatitis multiformis; Pustules associated with 
other lesions. 



52 SKIN DISEASES. 

5. Furuncles; A pustule seated at the apex of an in- 
flamed, painful, and slightly elevated spot. 

6. Scabies; Isolated pustules, especially frequent about 
the hands and wrists. 

7. Syphilis; Pustules succeeding papules, or occurring 
without them. 

8. Variola; Umbilicated pustules which follow vesicles, 
and which were preceded by papules, discrete or con- 
fluent. 

The common feature of these three lesions — vesicle, 
bulla, pustule — is a fluid exudation — serous, sero-fibrin- 
ous, or purulent — which lifts up a greater or less extent 
of horny epidermis, producing an elevation on the skin, 
and the lesion consists of an effused fluid, kept in bounds 
by a limiting membrane. 

A vesicle, bulla, or pustule having formed may further 
progress in one of several ways. After a few days the 
effusion may be reabsorbed without rupture of the epi- 
dermis, and leave nothing but a loosely attached scale, 
which soon exfoliates. On the other hand, the epidermis 
may rupture in a day or two, the effusion be poured out, 
and the whole dry up to a small crust, which in a few 
days more is wholly detached; or, still again, a vesicle or 
pustule may rupture promptly, but from the denuded sur- 
face a serous or purulent fluid may continue to exude for 
several days or even weeks. 

A papule is a small, solid elevation of the skin. In 
this case the exudation into the skin is of a plastic char- 
acter, mostly cells with but little fluid effusion — not suffi- 
cient, in fact, to produce a vesicle. A papule may disap- 
pear in a few days by absorption of the exudation, or 
may be gradually converted into a pustule; or may un- 
dergo ulceration, or may even persist without alteration 
almost indefinitely. 



CLASSIFICATION OF THE ELEMENTARY LESIONS. 53 

The principal diseases in which papules are found, and 
their chief features are: 

1. Acne; Papules of varying size, chiefly met with on 
the face, shoulders, back, and chest, and frequently 
changing into pustules. 

2. Erythema multiforme; Grouped papules, most fre- 
quent on the extremities. 

3. Eczema; Scattered, or more or less closely aggre- 
gated, on the arms, inside of thighs, and elsewhere, fre- 
quently accompanied with scratch-marks. 

4. lyichten simplex; Scattered papules, frequentlj^ met 
with over the entire surface. 

5. Eichen planus; Elat, umbilicated papules, greatly re- 
sembling those of a papular syphilide. 

6. Lupus; Persistent and gradually increasing in size; 
becoming tubercles, usually on the face. 

7. Milium; Minute white papules on the e3^elids and 
contiguous skin. 

8. Molluscum contagiosum ; Umbilicated papules, con- 
taining a cheesy matter which may be pressed out, fre- 
quently predunculated — in this respect differing from 
acne papules, which are not pedunculated. 

9. Prurigo; Hard, and under or in the skin, not much 
elevated, and with little change in color of the skin; more 
easily felt than seen, and accompanied with scratch- 
marks. 

10. Rubeola; Red papules, covering the entire surface, 
and accompanied with febrile symptoms. 

11. Scabies; Small papules, usually accompanied with 
other lesions, and generally with their apices scratched off. 

12. Strophulus; Red papules, in infancy only. 

13. Syphilis; More or less generalized reddish or copper- 
colored; may degenerate into pustules, or become covered 
with a fine scale. 



54 SKIN DISEASES. 

14. Urticaria; Large papules, lasting a few hours only, 
but succeeded at short intervals by others, and accom- 
panied with sharp pruritus. 

15. Variola; Discrete or confluent, changing into vesi- 
cles, and later into umbilicated pustules; usually accom- 
panied with severe general symptoms. 

16. Xanthelasma; Yellowish and slightly elevated, 
most frequent about the eyes, but may occur elsewhere. 

A tubercle is a solid elevation of the skin, larger than a 
papule, but agreeing with it in other respects and capable 
of undergoing the same changes — namely, absorption, 
pulsation, ulceration, or indefinite prolongation. 

The principal diseases in which tubercles are found, 
and their chief features are: 

1. Acne; Tubercles on face, back, etc., with inflamed 
bases, and usually terminating with suppuration. 

2. Fibroma; Single or multiple, and scattered over all 
parts of the body. 

3. Framboesia; Fungous tubercles, frequently of large 
size — very rare. 

4. Keloid; Flat tubercles, or flattened elevations of the 
skin, with projecting finger-like processes. 

5. Lentigo maligna; Commencing as macules, becom- 
ing papules, and afterward tubercles, frequently with 
ulceration. 

6. Leprosy; Reddish-brown tubercles on the forehead, 
ears, and other parts of face and body. 

7. Lupus; Solitary or but few reddish- violet tubercles, 
of very slow increase, and terminating with ulceration. 

8. Morphoea; Flat, light-colored tubercles, followed by 
atrophy, from one to a dozen — rarely more. 

9. Rosacea hypertrophica; Confined to the nose. 

10. Syphilis; Copper-colored, terminating with suppu- 
ration or ulceration. In early syphilis, numerous; in late 



CLASSIFICATION OF THE ELEMENTARY LESIONS. 55 

syphilis, number of lesions limited, and occurring in 
groups. 

Scales are collections of cells of the stratum corneum, 
which, instead of pursuing their usual and normal course, 
collect in undue number and quantity, and are loosely or 
firmly attached to the skin in more or less heaped-up 
masses. When these scales are small in size, loosely at- 
tached, like a fine powder or meal scattered over the sur- 
face, they are termed farmaceous ; on the other hand, 
when large, thick, heaped up, and firmly attached, they 
are called furfuraceous. 

The principal diseases in which scales are found, and 
their chief features are: 

1. Dermatitis exfoliativa; Large scales, consisting of 
flakes of horny epidermis; sometimes several inches in 
extent. 

2. Eczema; Medium size, scales occurring in the last 
stage of the disease, and frequently preceded by exuda- 
tion and crusting. 

3. Ichthyosis; Very adherent thick scales, the disease 
commencing in early life and continuing indefinitely. 

4. Lupus erythematosus; Very fine adhering scales, 
situated on a reddened, infiltrated base. 

5. Pemphigus foliaceus; Large scales, due to imperfect 
formation of bullae. 

6. Pityriasis simplex; Fine white scales on a surface 
but little affected otherwise, and readily exfoliating. 

7. Pityriasis rubra; Fine scales on a reddened surface, 
usually generalized. 

8. Psoriasis; Thick, adherent, imbricated white scales 
on a reddened infiltrated surface, more or less generalized. 

9. Syphilis; Small scales at the summit of papules, or 
thicker and larger on reddened infiltrated surface, more or 
less generalized. 



56 SKIN DISEASES. 

lo. Trichophytosis capitis; Fine scales among hair- 
stumps on round patches. 

Fissures are solutions of continuity, and are character- 
ized by varying length and depth, but with scarcely 
appreciable breadth. They rarely extend deeper than 
through the horny or Malpighian layers, though some- 
times they penetrate the cutis vera. They are frequently 
accompanied with a scanty serous exudation. 

The principal diseases in which fissures are found, and 
their chief features are: 

1. Eczema; Especially at flexor aspect of joints, palms 
of the hands, and soles of the feet. 

2. Leprosy; Especially at extensor aspect of small 
joints or between them, and usually accompanied with 
anaesthesia. 

Ulcers are solutions of continuity of three dimensions — 
namely, length, breadth, and depth. Their borders may 
be sharp cut and perpendicular to the skin, or may be 
sloping or overhanging, features which often afford a 
valuable clew to the origin of the lesion. jj 

The principal diseases in which ulcers are found, and 
their chief features are: 

1. Carcinoma; Ulceration on the elevated surface of a 
carcinomatous tumor; underlying tissues hard. 

2. Eupus; Ulceration following one or more tubercles, 
sometimes becoming carcinomatous. 

3. Scrofula; Irregular and uneven, frequently with 
overhanging margins. 

4. Syphilis; Round or ovoid, with straight *' punched- 
out ' ' margins. 

5. Simple: Round or oval, with sloping margins. 

Tumors : ^IR 

I. Carcinoma (epithelioma); Usually solitary, hard, 
and terminating by ulceration. 

1' 



i. 



CLASSIFICATION OF THE ELEMENTARY LESIONS. 57 

2. Elephantiasis; Sometimes immense tumors of the 
genitals, which in rare instances have reached the weight 
of one hundred pounds. 

3. Fibroma; Solitary or multiple, of varying size, 
sessile or pedunculated, without tendency to ulceration. 

4. Papilloma; Warty tumors, of varying size and num- 
ber. 

5. Sarcoma; Soft "fleshy" tumors, bleeding readily; 
usually solitary, unless accompanied with melanotic de- 
posit. 

6. Steatoma; Enlarged sebaceous glands, with reten- 
tion of secretion. 

In addition to the above there are certain other lesions, 
some of which are secondary, while others are peculiar to 
certain special diseases, and will be described in connec- 
tion with them. 

With the foregoing list of diseases and lesions, and 
with their chief peculiarities visible at a glance, there 
should be but little difl&culty in working out an analytical 
diagnosis in the great majority of cases of cutaneous dis- 
ease. We would, however, advise the student to pursue 
the following course: First, determine the predominant 
lesion, then turn to the list of diseases which are charac- 
terized by that lesion, and see how closely the descrip- 
tions there given agree with the appearances presented; 
and, when a choice is made, carefully read the descrip- 
tion of the disease itself as found in later pages of the 
book. Should the disease in question present more than 
one lesion, examine the lists of diseases under each lesion, 
and proceed as before. Several years' experience in 
studying dermatology has satisfied the writer that the 
pursuit of the method here laid down will enable the 
student to become a prompt and correct diagnostician in a 
surprisingly short time. He will, of course, meet with 
5 



58 SKIN DISEASES. 

cases in which he will not succeed, but he should remem- 
ber that cases not infrequently occur which puzzle even 
the most expert. 

The subject of diagnosis, however, cannot be dismissed 
without allusion to certain eruptions or rashes that arise, 
not spontaneously, but after the ingestion of certain drugs 
that have been administered for other diseases. The fol- 
lowing named drugs have been known to give rise to the 
lesions which follow their titles, viz. : 

Acid, Carbolic. — Erythema. 

Acid, Salicylic. — Erythema, vesicles, papules, and 
wheals 

Aconite. — Erythema and vesicles. 

Antimony. — Vesicles and pustules. 

A7itipyrin. — Papules. 

Arnica. — Erythema, bullae, and scales. 

Arsenic. — Erythema, papules, vesicles, bullae, pustules, 
and wheals. 

Bellado7i7ia. — Erythema. 

The Bromides. — Erythema, vesicles, bullae, pustules, 
papules, tubercles, and wheals. 

Cannabis Indica. — Vesicles. 

Chloral. — Erythema, papules, vesicles, and wheals. 

Cinchona derivatives. — Erythema, papules, vesicles, 
and wheals. 

Copaiba, — Erythema, papules, vesicles, bullae, and 
wheals. 

Digitalis. — Erythema and wheals. 

Hyoscyamus.—^XYi\\.^ni2. and w^heals. 

The Iodides.— Erythema, papules, vesicles, bullae, 
pustules,, and wheals. 

Iodoform. — Erythema, papules, and vesicles. 

Napthalhi . — Papules . 

Phosphorus. — Bullae. 



CLASSIFICATION OF THE ELEMENTARY LESIONS. 59 

Santonin. — Papules, vesicles, and wheals. 
Sulphonal. — Macules, papules. 
Sulphur. — Erythema and vesicles. 
Violet-water (locally ) . — Papules. 

Pathology. 

The pathology of the skin presents no essential differ- 
ences from the pathology of other parts of the bodj^ — that 
is, the same morbid processes that are met with else- 
where also find expression in the dermal tissues. For 
instance, congestion, inflammation, hypertrophy, atrophy, 
cedemas, infiltrations, degenerations, neoplasms, pseudo- 
plasms, nervous derangements, etc., are the processes 
which result in the production of the various lesions that 
constitute the essential visible characteristics of cutaneous 
disease. In addition we have certain parasitic invasions, 
of both animal and vegetable origin. The complex 
structure of the skin, and of the special organs contained 
in it, together with the anatomical peculiarities of the 
appendages, give rise to an almost infinite variety of 
changes. • 



CHAPTER IV. 



ETIOLOGY. 

The general question of the treatment of diseases of 
the skin involves the consideration of the different and 
several indications, and of the means at our command for 
the fulfillment of these indications. Before, however, we 
can properly appreciate the special features appertaining 
to any one given morbid condition, it is better to devote 
a little time to the discussion of the general factors which 
lead to the development of cutaneous disease; in other 
words, to consider the question of etiology. 

Primarily it may be stated that cutaneous lesions are 
due to influences or forces from without, or from those 
which exist or arise within the body. To the former 
class may be assigned such as depend on temperature 
and climate, such as are due to traumatisms of various 
kinds, such as result from various parasitic invasions, 
etc. This is in reality but a limited class; on the other 
hand, the etiological factors which arise within the body 
itself are very numerous. We will, however, first con- 
sider the external causes. Excessive heat or direct ex- 
posure to the sun may excite undue activity of the sudor- 
iferous glands, and result in the production of sudamiiia^ 
or the extremely annoying papular affection known as 
lichen tropicus; or to an erythematous or even vesicular 
inflammation, commonly known as sunburn; or to the 
more trivial affection called ephelis, or freckles. Excess- 
ive cold may result in absolute congelation of exposed 



ETIOLOGY. 61 

portions of the integument, followed by death and slough- 
ing ofF of the parts; or a less degree of cold may excite 
the condition known as pernio, or chilblains, or in some 
persons produce chapping or fissuring of the skin; or, by 
depressing the general vitality, promote an outbreak that 
otherwise would not have occurred. Of the animal para- 
sites that may infest the body, the different varieties of 
pediculi, or lice; the acarus, or itch insect; the leptiis, etc., 
produce affections more or less annoying, but usually 
readily removable. On the other hand, the infinitely 
minute and to the naked eye invisible parasites of vege- 
table origin, as the achorion and the trichophyton, give 
rise to affections which are exceedingly tenacious, and 
sometimes well-nigh incurable. 

The internal causes of cutaneous diseases, however, 
are far more frequently in operation, and are far more im- 
portant than those of external origin. In this class we 
may place those affections of the skin which are due to 
pre-existing lesions of some part of the nervous system, 
as, for instance, zoster, which results from an anterior 
lesion of the ganglion attached to the posterior root of a 
spinal nerve; or some of the lesions of leprosy, which 
succeed certain degenerations of the spinal cord. The 
nervous system, however, may be in a perfectly sound 
condition, and yet act as the medium for the transmission 
of. some internal irritation to the surface; thus, the gastric 
irritation resulting from the ingestion of shell-fish may 
manifest itself chiefly on the skin in the form of urticaria, 
or a chronic irritation of the pelvic viscera may be the 
active cause of rosacea. Again, cutaneous lesions maj^ be 
due to internal changes which have in turn arisen from 
external causes as, for example, the cutaneous manifes- 
tations of syphilis, which are due to an internal dyscrasia 
produced by the entrance into the body of a certain form 



62 SKIN DISEASES. 

of morbific matter from without. Leprosy may be placed 
in the same. category. 

Still another internal cause of cutaneous lesions will be 
found in that condition of ill nutrition or imperfect as- 
similation known as scrofula or stru77ia. 

Finally, we may have external lesions resulting from 
the accumulation in the blood of certain materies morbi. 
Most of the so-called medicinal rashes are due to this. 
Or, again, we may see the materies morbi generated 
within the body itself through imperfections in the diges- 
tive, assimilative, or excretory functions As a matter of 
fact, I believe that fully one-third of the cases of cutane- 
ous disease which come under the physician's eye are due 
to this last-named cause. If this be true, a somewhat 
brief consideration of this topic will not be out of place 
at this point. 

In order that nutrition may be healthily carried on in 
any part, there must be — (i) a proper state of the blood; 
(2) a proper condition and behavior of the tissues to be 
nourished; and (3) a right exercise of the controlling in- 
fluence exerted by the nerves. And these three must 
work harmoniously together. Deviations from health may 
originate consequently from a flaw in any one of the three 
conditions above named. The theoretical origin, there- 
fore, of diseased changes in the skin may be specially in 
the blood, as we see in zymotic affections, and here the 
skin affection is only symptomatic or a part of a more 
general disease; in the tissues themselves, as seen in the 
case of warts, cancer, keloid, psoriasis; or in the nerves, 
as in pruritus, and, it is thought and now generally taught, 
herpes, pemphigus, and urticaria. If the exact origin of 
disease be not as stated, the parts of the system chiefly 
concerned in the production of diseased conditions may 
be emphatically in one case the blood, in a second the 



I ETIOLOGY. 63 

j 

I tissues, and in a third the nerves. But of course, inas- 
I much as the ordinary action of these three agencies is 
i bound up and related in the closest manner in health, the 
' misbehavior in disease of one affects, secondarily, the 
proper action of others of the three agencies concerned 
in healthy nutrition. So that all are more or less involved 
I in disease when fully developed, but primarily one or the 
I other is mainly concerned in it. 

Now there is much readiness to ascribe disease to 

changes in the blood, but not to sufficiently recognize the 

.' influence of perversions in the inherent cell-life of the 

i skin structures, nor the controlling supervision of the 

; nerves in the generation of cutaneous disease. Cancer 

is an example of disordered tissue-life. 

It is more than probable that the origin of some dis- 
eases of the skin may really be in the central nervous 
,' system, and the cutaneous trouble is the effect of a 
, general disturbance of the nervous system; or in the 
' nerves themselves that run to the affected part; at any 
, rate the nerves are mainl}^ concerned, or they may consti- 
■ tute the agency by which the morbid changes in the skin 
! are produced. 
i| Some of the causes that produce altered states of the 

blood-current, are: 
I I . Poisons of acute specific diseases— for example, those 
1 of small-pox, etc 

2. The circulation of special poisons, be they animal— 
j syphilitic; medicinal substances — arsenic, etc. ; or dietetic, 

j such as shell-fish, giving rise to urticaria, roseola, ery- 
[ thema. 

3. Dietetic errors, as in wine-drinkers, high-livers, 
non- vegetarians, etc., leading to the increase of urea and 

I uric acid in the blood. 

I 4. The tuberculous, scrofulous, and lymphatic dys- 



64 SKIN DISEASES. 

crasise, giving rise to non-specific eruption — impetigo, 
acne. 

5. The gouty and rheumatic diatheses, as in lichen 
agrius. 

6. Altered and lowered nutrition from such causes as 
bad living, povert}^, misery. 

7. The accumulation of excreta in the blood from non- 
excretion, suppression of natural discharges, kidney dis- 
ease, etc. 

8. Convalescence from severe and lowering diseases by 
which the body is rendered much less able to resist 
disease. 

9. Climacteric, or endemic influences, often malarial in 
nature, which act by deteriorating the system generally. 

10. Disorders of the liver and spleen leading to pig- 
mentary deposits in various parts, jaundice, and pruritus, 
etc. 

lyocal irritants frequently lead to alterations of tissue, 
and rank here with burns, scalds, parasites, the occupa- 
tions of bricklayers, masons, and washerwomen, etc., as 
causes of local mischief. 

Dyers, and those who handle cheap clothing, frequently 
suffer from erythema due to the irritant action of dyes. 

Certain tissue peculiarities may be inherited. The 
father may transmit dispositions in tissues to behave in 
particular ways directly to the child, as a local peculiarity, 
independent of any blood state, and in this sense psori- 
asis, cancer, ichthyosis, may be hereditary. 

There are two sources of local irritation that deserve 
special notice. I refer to the use of flannel w^orn next 
the skin, and scratching. Some skins are so irritable in 
health as to be excited to an unbearable degree by the 
use of flannel. In a very large number of cases of skin 
disease pruritus is in this way intensified and the disease 



ETIOLOGY. 65 

even protracted, and in proportion to the degree of un- 
cleanliness. Flannel acts, as a mechanical irritant, by 
augmenting the loral heat, and intensifying reflex action. 

Scratching plays an important part in the modification 
of skin diseases, most of which are accompanied by itch- 
ing. To relieve itching scratching is the most natural 
thing to do. What does it do? i. When there is no 
eruption it may produce one. 2. It augments and modi- 
fies existing eruptions. 3. When the disease is non- 
contagious, secretion, in scratching, may be transfered 
from place to place; and if acrid, set up local inflamma- 
tion; and when cantagious, scratching is the surest 
method of inoculation, as in the case of contagious im- 
petigo. Children in this wa}^ transplant the disease from 
the head to various parts of the body. Mothers, beyond 
a doubt, get the disease about their hands from contact 
with children. 

Upon the nature of the cause depends the cojitagious 
or no7i- contagious qualit}^ of any disease. It is generally 
conceded that parasitic and the acute specific diseases are 
contagious. 

Sex has some influence as a cause of disease; males 
suffer by preference from sycosis, pemphigus, psoriasis, 
eczema, and epithelioma; and females from acne, kelis, 
and lupus especiall3\ 

In our own clime race would seem to exert an influence 
upon lesions of the skin. Dr. Morrison, of this city, has 
preserved histories of five hundred cases of skin diseases 
in negroes, and forms the following conclusions: 

" Acne and lesions due to pediculi and insect-bites are 
uncommon. Mosquitoes, the cimex lectularius, and in- 
sects in general, do not produce the same ill effects" 
(My own observation, which has been quite extensive, 
would lead me to disagree with the doctor in regard to 



66 SKIN DISEASES. 

the pediculi. They are very apt to have lesions from this 
cause). " Ainhum is peculiar to the race, two cases hav- 
ing been seen; one man had lost one little toe, and that 
of the opposite foot was affected." 

Chancre is more indurated, and more frequently com- 
plicated with phimosis. 

Chloasma appeared to show a lessening of pigment, in- 
stead of an increase. (Dr. Heitzmann takes issue with 
Dr. Morrison on this subject, and asks how can a diminu- 
tion of the normal pigment be termed chloasma, an in- 
creased pigmentation being usually understood by that 
name.) 

Chilblain is common. 

Elephantiasis Arabum mostly follows syphilis. 

Erythema multiforme is difficult to diagnose, as are all 
erythematous conditions. 

Eczema appears to be more amenable to treatment; 129 
cases are recorded. 

Favus and pediculi capitis are rare. (The latter is 
common. D.) 

Keloid appears common, especially false keloid after 
injuries. It is seen following variola and zoster, and after 
piercing the ears. 

Lupus is seldom encountered. 

Lymphadenitis is quite common. 

Pruritus is much complained of, and it is said that 
syphilitic lesions itch in this race. 

Scabies was rarely seen. (I 'have seen several cases.) 

Syphilis is abundant. 

Scaly and pustular lesions are often seen. 

Urticaria wheals do not seem to be so elevated, but 
very itchy. 

Dr. Atkinson reported a pustular folliculitis very fre- 
quent in young, closely-shaven negroes. The pustules 



ETIOLOGY. 67 

penetrate into the follicles of the beard without producing 
that degree of irritation which is to be called sycosis. He 
thinks that fifty per cent, of the young negroes who shave 
very close have it. 

He has noticed that it is common to find deep and per- 
manent pigmentation after the application of a mustard 
plaster. (I have often noticed the same condition.) 

Involution occurs after a time in keloidal tumors; they 
become flaccid, and, after some years, soft. 

Pediculosis appeared to him to be as frequent in colored 
as in white children. 

, Acute exanthemata produce, upon desquamating, a 
peppered appearance, looking as though the skin were 
dusty or sprinkled with fine powder. In scarlatina it is 
due to the sHght elevation of the papules, which is not 
evident in Caucasians. 

Whatever be the causes of the various cutaneous affec- 
tions, we are chiefly concerned with the means that the 
physician has at his command with wdiich to treat them 
successfull5^ First of these is hygiene. It goes without 
saying that recovery is facilitated by the substituting 
of good hygienic surroundings for bad ones; and under 
this head we may include fresh air, wholesome food, 
cleanliness, exercise, and seasonable clothing. It is 
hardly necessary to go into details on these points, if the 
fact is recognized and remembered; and in all chronic 
affections of the skin, and in some of the acute ones, these 
matters should be inquired into, and corrected when pos- 
sible. Our resources further include mechanical, chemi- 
cal, and pharmaceutical remedies, and also electricity. 
An elastic bandage applied to an old, infiltrated eczema 
of the leg is an illustration of the first; an active caustic 
applied to an obstinate ulcer ma}- be considered as an ex- 
ample of the second; but by far the largest proportion of 



68 SKIN DISEASES. 

remedial agents will be found in the pharmaceutical di- 
vision. This class embraces remedies used both internally 
and externally. The homoeopathic materia medica is 
rich in remedies having a direct and specific action upon 
the skin. And the fact that we always prescribed for the 
totality of symptoms manifested in our patient, laying 
stress upon the affection as shown in the' skin only as a 
symptom of the diseased condition, often leads us to pre- 
scribe, with the happiest results, a remedy not ordinarily 
classed among the skin remedies. Great improvements 
have been made by both schools, in the last few years, in 
the external applications. Formerly lotions and oint- 
ments were almost the only means of making external 
applications, but within recent years we have learned the 
value of collodion, of solutions of gutta-percha {trau- 
maticlri), mixtures of gelatin with glycerin, starch, etc., 
plasters and other bland compounds and mixtures, as ex- 
cipients for the drugs that we desire to bring into direct 
contact with the diseased parts. 

Electricity, also, as a destructive agent (^electrolysis) , or 
as a modifier of local nutrition, or as an excitant of reflex 
action, plays a by no means humble part in the treatment 
of these diseases. 

If physicians would give as much thought and care to 
the study of these affections as they do to others, not only 
would our armamentarium be enriched and purified, but 
our successes would be greater and failures less. They 
should not be content with the mere diagnosis and nam- 
ing of the disease, but should study the peculiarities of 
each case, and the influence exerted by the general health 
or condition of the patient on the special lesions in ques- 
tion. 

When treating of the several lesions, therapeutically, 
it shall be my endeavor to give the best that is recom- 



ETIOLOGY. 69' 

mended by both schools of medicine. We must bear 
in mind that " The physician's highest and only calling 
is to restore health to the sick." "The highest aim of 
healing is the speedy, gentle, and permanent restitution 
of health, or alleviation and obliteration of disease in 
its entire extent, in the shortest, most reliable, and safest 
manner, according to clearly intelligible reasons." 

Keeping these aphorisms of our illustrious master ever 
before us, we will proceed in the next chapter to take 
up the different lesions of the skin, and study them with 
the best light we have at our command. 



CHAPTER V. 



LOCAL DERMAL INFLAMMATIONS, 

Under the head of local dermal inflammations we in- 
clude those diseases which partake essentially of the 
nature of local diseases, and are characterized by inflam- 
mation, as the primary and the essential phenomenon. 
By inflammation we understand not merely hypersemia, 
with engorgements of the affected parts by blood, so that 
the parts are swollen and red and hot, not only hypersemia, 
with stasis in the vessels and serous effusion in addition; 
but also an increased activity in the tissues themselves 
outside the vessels, and the formation of new products, 
or '' inflammatory exudation," to use a commonly em- 
ployed term. The character and source of these new 
products are important items in this matter of inflamma- 
tion. As regards the character of the new product, its 
typical features, and ultimate destination in marked cases 
are those of pus. Pus, in fact, is the highest grade of 
inflammatory products, but pus is not necessarily formed, 
and it is held that the new products may give rise to the 
production of a tissue-like connective tissue. Pus is de- 
rived from two sources — namely, from white blood cells, 
and also from connective-tissue corpuscles. There are 
three leading changes observed in inflammatory exuda- 
tion — resolution^ organization, and suppuration. 

The local inflammations we are about to consider are 
generally characterized by hypersemia and the presence 



LOCAL DERMAL INFLAMMATIONS. 71 

of inflammatory infiltration. They are the erythemata; 
eczema, or catarrhal inflammation; that form which com- 
mences as a serous catarrh of the papillary layer, and is 
followed by the outpouring of sero-purulent discharge, as 
in catarrh of the mucous membrane; plastic or papular 
inflammation, in which the inflammation is characterized 
as much b}^ the absence of serous as by the deposit of 
fibrinous exudation; suppurative inflammation; and lastly, 
hyperaemia, accompanied by excessive formation of epi- 
thelial and certain cell growths in the papillary layer, con- 
veniently termed squamous inflammation, as in psoriasis. 

Two of these groups or classes might be separated 
from inflammation perhaps, and dealt with as hyper- 
aemias solel^^ and these are the first and the last of the 
above named. In the former there is h3'peraemia and 
serous exudation, as in erythema; but what is the im- 
portant thing to notice in relation to the point under dis- 
cussion, there is no cell proliferation or cell infiltration in 
the tissues. If the hyperaemia is persistent then there 
foUow^s in due course hypertrophy. To avoid,' however, 
making another group in classification I have grouped 
the erythematous diseases under the head of local infiam- 
mations. With regard to " squamous inflammation," 
there is here only h3^persemia and hyperplasia or hj-per- 
trophy, and no actual inflammatory infiltration. Psoriasis, 
the type of the class, is on the borderland only of inflam- 
mation; but we will group it under inflammations for the 
present at all events. 

The reader will very naturally want to be told wherein 
lies the difference between hypertrophy and h3'perplasia 
following hyperaemia, on the one hand; and the changes 
that occur in the skin in zjanotic diseases, and those that 
are observed in lupus, syphilis, and leprosy on the other 
hand; and what are the differences that lead derma- 



72 SKIN DISEASES. 

tologists to make the special class of diseases to be dealt 
with in this chapter. In the first place, with regard to 
the local changes in the zymotic diseases — as small-pox 
and typhoid — these are only parts of a general malady, 
and could not be regarded in a group characterized essen- 
tially by peculiarities of local change. From an etiologi- 
cal point of view it would be impossible to do so. Then, 
in regard to lupus, syphilis, etc., there are certain anatom- 
ical characters and behaviors about the growths, which, 
no less than peculiar concomitants of associated constitu- 
tional states and the like, that mark them as belonging to 
a special class of neoplasmata or heterologous new forma- 
tions. In regard to the distinction to be drawn between 
hyperplasia consequent on inflammation, and hyper- 
trophy, the latter is much slower, even if the etiology be 
left out of view; there is in the one the escaped blood 
cells developing into the new tissue, and in the other the 
increased supply of blood and transuded serosity. But 
the two have certain analogies, and it is difiicult if not 
impossible to draw a line between hypertrophy and in- 
flammation. But further, it may be said — and this ap- 
plies to tumors and special neoplasms, as lupus and 
syphilis — whilst the inflammatory infiltration is caused by 
some irritant, the tumor or heteroplastic neoplasm arises 
spontaneously, or from a specific cause acting generally 
and modifying nutrition. There is with inflammation the 
accompanying heat, redness, pain, and swelling, and 
these "signs" acutely developed; there is less tendency 
to spontaneous cure with tumors; and lastly, the inflam- 
matory exudations directly tend to the formation of pus. 

Erythematous Diseases. 

The diseases which rank under this head as having 
simply erythema as their primary and only feature are ex- 



ERYTHEMA. 73 

ceedingly simple and well defined. They are three: ery- 
thema, roseola, and urticaria. These erythemata are 
characterized mainly by the occurrence of active hyper- 
aemia of the longitudinal plexus of the skin (erythema), 
and its immediate consequences — for example, serous 
effusion — nothing more. In erythematous diseases the 
redness may be rosy (roseola), or bright red (erythema 
urticaria); in urticaria "wheals" are present. The 
erythema in these diseases is removable by pressure. 
Unlike the more common eruptive diseases of the skin, 
the erythemata exhibit the closest connection between 
local and constitutional phenomena. Febrile symptoms 
antecede and are relieved by the development of the 
erythema in the exanthemata, showing that the local skin 
changes are secondary, and onl}^ parts of a general dis- 
turbance which is primar3^ I shall include under this 
head sections on follicular hyperaemia, pellagra, and cer- 
tain medicinal rashes. 

Erythema. 

The term erythema^ used by itself, is the name of a 
symptom, not of a disease, and may be applied to any 
reddened or congested surface not accompanied with ele- 
vation, and may be produced by a variety of causes. 
There are, however, two well-marked affections, erytheyna 
multiforme and erythema nodosum, which are distinct 
morbid entities, and deserve careful consideration. 

Erythema Multiforme. 

The eruption of erythema multiforme is a diffused 
patch of redness over which circumscribed elevations, 
also red, are scattered. These elevations may be few or 
plentiful, and may be from an eighth to three-quarters of 
an inch in diameter. The small ones, according to size, 
6 



74 SKIN DISEASES. 

may be called papules or tubercles, while the larger ones, 
which are always flattened, may assume the appearance 
of an elevated ring, around which a second or a third 
ring may develop. On the flattened tubercles, of medium 
size, vesicles are sometimes met with, and hemorrhagic 
effusions may also occur within them. 

These lesions rarely persist for more than a few days, 
or at most a week or so, at the end of which time they 
gradually subside and disappear, leaving after them slight 
stains, which last a few days longer. After the disap- 
pearance of the first eruption, or even while it is still in 
full bloom, a second crop of lesions may come out, and 
after these a third, prolonging the trouble in this way for 
several weeks and even months. Two or more of the 
lesions mentioned may coexist, and the eruption may ap- 
pear on any part of the surface, but as a rule it prefers 
the extremities. Slight febrile action may precede the de- 
velopment of the eruption, but it soon disappears, and 
there is rarely any accompaniment other than slight itch- 
ing. The causes of erythema multiforme are obscure: oc- 
casionall}^ it appears due to errors of diet, and sometimes 
also to uterine disorder. The prognosis is favorable, so far 
as any trouble may result from the eruption; but when it 
is prolonged for weeks, as is sometimes the case, it proves 
very annoying. It attacks by preference the backs of the 
hands and feet, the arms, the legs, and the forehead. It 
is mostly an affection of children and young people. It 
attacks females more than males, and prevails in the 
spring and fall. Individuals who are troubled with it 
one year are apt to have it again at the same time in suc- 
ceeding years. When occurring on the fingers it closely 
resembles chilblains. It may be commonly known by its 
superficial and protean character, and its symmetrical 
distribution. 



ERYTHEMA NODOSUM. 75 



Erythema Nodosum. 

This is a much more important but also rarer affection 
than the preceding one. The disease is characterized by 
the eruption of reddish tumors, from the size of a bean to 
that of a small egg, and usually situated upon the lower 
extremities, between the knee and ankle. For a day or 
two the depth of color increases, then becomes somewhat 
purplish, and with the " black-and-blue " appearance 
which accompanies hemorrhagic effusions, and finally 
passes into the stage of green and yellow, like an ordinary 
bruise. A week or ten da3^s ma}^ be occupied by these 
processes; and, as the color changes, diminution of size 
takes place, and in about two weeks complete resolution 
is effected. Suppuration very rarely occurs. The num- 
ber of the nodes is usually limited to three or four, but 
may reach nine or ten, and may appear on the thighs and 
upper extremities as well as the parts already named. 
The swellings are usually a little painful for the first day 
or two, but not afterward. Relapses may prolong the 
disease for several months. Occasionally the eruption is 
ushered in by febrile action, but not in all cases. It usu- 
ally occurs in 3^oung females, and is not unfrequently 
accompanied by menstrual derangement. In many cases, 
however, the eruption is preceded by or complicated with 
arthritic pains. This has led many writers to believe 
the affection to be more or less closely connected with 
rheumatism. 

The disease is self-limited, requiring no special treat- 
ment other than sedative applications to the affected 
parts. 

In erythema multiforme the allopaths claim that * ' Un- 
less the cause of the affection be discovered, little need 



76 SKIN DISEASES. 

or can be done in the way of treatment, and the affection 
may be left to run its course, which it will usually do in 
two or three weeks, and may not return until the follow- 
ing season, for in some persons this disease appears to 
affect a predilection for the spring and autumn months, 
returning annually at one or the other of these seasons. ' ' 
Treatment. — When there is much itching and burn- 
ing either a carbolic acid or veratrum viride lotion may be 
used. When the opposing surfaces are much inflamed 
they may be protected by dusting with buckwheat 
powder, or equal parts of starch and zinc oxide. Espe- 
cial attention should be paid to cleanliness, and all irri- 
tants should be removed. Poultices are apt to do more 
harm than good, and better be avoided. Particular at- 
tention must be paid to the diet; such food as corn-flour, 
maizena, and the like must be forbidden, and proper 
nutritive substitutes be given to children in conjunction 
with a suitable quantity of milk. 

In the erythemata dependent upon general causes you 
must always remember the effect of ingesta; that a gouty 
or rheumatic habit, disordered menstrual function, denti- 
tion, delicacy of skin, or lymphatic temperament, are 
present in greater or less degree. It is important to allow 
the patient the use of an unstimulating diet only, to for- 
bid him spirits, wine, and beer, to clear out the bowels, 
and in the early stage to adopt a soothing regime, with 
tepid sponging and emollient baths. 

Bed-sores are best treated by attempting to ' ' harden ' ' 
the skin in the early stage by spirit applications, removing 
pressure as much as possible at later stages by pads, 
cushions, and water-beds, and by using charcoal poultices 
or soap plaster spread on soft leather to the sores. For 
chilblains, equal parts of turpentine and tincture of 



ERYTHEMA NODOSUM. 77 

Aconite, and soap liniment, together with the indicated 
remedy, constitute the best treatment. 

The internal remedies for erythema are: 

Aconite. — Erythema excited by the action of the sun's 
rays. 

y^thusa. — Appearance and disappearance of reddish- 
blue spots on the trunk and left leg. General malaise. 

Aila7ithus. — Irregular spots of capillary congestion. 
Dark almost livid eruption on the forehead. 

Arsenicum iodide. — Erythema, especially of the face. 

Belladonna. — Inflamed red patches, /rr^^zz/ar/y-shaped 
scarlet spots over the body. More on face and upper part 
of body. 

Berberis. — Mottled spots as after a bruise on the right 
shoulder, left humerus, back of the hand and wrist. 

Bryonia. — Red round hot spots on the malar bone, as 
large as peas. 

Cadmium sulph. — Red spots on the extremities. 

Chelidonium niaj. — Round red spots, size of a half 
dollar, accompanied with burning pain, on anterior surface 
of the forearms and face, disappearing in a few hours. 

Chloral hydrate. — Bright red or bluish erythema over 
the whole body, permanent under pressure, mottled with 
livid patches and deep red spots. Pruritus of the whole 
skin. 

Crocus sat. — Circumscribed red spots on the face, which 
burn. 

Co7idurango. — Erythematous blotches on the face and 
arms. 

Gelsemiuvi. — Papulous eruption on the face resembling 
measles. 

Gossypium. — Round little spots with pale red circles 
around the knee caps and over the shin bones, w^hich 
itch very much. 



78 SKIN DISEASES. 

Lactic acid. — Several bright red blotches on the an- 
terior surface of the leg, with slight burning and no itch- 
ing. Relieved by cold. Eruption brightest at 8 A. m. 

Laurocerasus. — Erythematous patches, terminating in 
dark red purple spots. 

Mercurius sol. — Eight red patches on the forearm and 
inner side of the thighs. Itching changed to burning 
by scratching. 

Mezereum. — Erythema on the legs in old people. 

Nux vom. — Pimples on the face with itching, burning 
after drinking wine or alcoholic liquors. 

Phytolacca. — Painful erythematous blotches of a pale 
red color. 

Pulsatilla nut. — Erythema of the scalp. Dark blue or 
red eruption on the legs and ankles. 

Rhus tax. — Ridges on the lower limbs. 

Sabadilla. — Red streaks on the arms. Worse from 
cold. 

Ustilago. — Fine eruption of a deep red color, about the 
size of a pin's head, appearing on any part of the body 
after scratching. On the neck it takes a circular form. 

Mr. M., a very large and fleshy 'man of exceedingly 
good habits and with no history of specidc trouble, 
presented himself for a long standing and obstinate ery- 
thema. The case had been prescribed for under nearly 
every conceivable diagnosis, the majority of physicians 
claiming it was due to syphilis. During a fishing expe- 
dition, some years ago, he thought he had been poisoned 
while in bathing, and since that time he has been exceed- 
ingly troubled with this persistent local inflammation. 
His unusual flesh had been a constant irritant, and being 
obliged to work for his living he had almost despaired of 
recovery. 

In the folds of his right groin and extending back be- 



ROSEOLA. 79 

tween the nates an immense phlegmonous surface was 
visible. So long had it existed that fissures and ulcera- 
tions, and excessive secretions of sweat and pus had com- 
plicated what might have been a short enduring, and 
simple sore. A rash, like measles, extended over the 
surrounding healthy skin. Extreme local itching and 
general aching pains made him exceedingly restless. 
These symptoms were always worse after midnight and 
during wet or cold weather. 

With these indications he was given Rhus tox. 30 four 
times daily for a week. He was directed to use a local 
wash of warm water and lanoline soap, being careful to 
wipe the parts to perfect dryness. He was then to use a 
dusting powder of aristol and wear an abdominal sup- 
porter to relieve any chafing. In four weeks he was 
entirely well. 

Roseola. 

It is important to know this disease — not so much be- 
cause it gives rise to any anxiety or trouble, as that it is 
likely to be confounded with measles and scarlet fever. 
Roseola is not generally considered to be a contagious 
disease, but rather occurs in an epidemic form. The 
eruption is preceded by some febrile symptoms; the rash 
is not much raised above the level of the surrounding 
part, and is of a rose color. It is in fact an erythema of 
a rosy hue. The eruption is patchy, and its color 
deepens somewhat as the disease advances. It is accom- 
panied by slight itching and sensation of heat. Before 
the eruption makes its appearance, and during the slight 
febrile symptoms, a slight redness of the mucous surfaces 
of the palate and fauces will be noticed on inspection of 
these parts. When not epidemic, roseola seems to de- 
pend chiefly upon derangements of the digestive appara- 



80 SKIN DISEASES. 

tus as a producing cause, though it may likewise be due to 
sudden changes of temperature, violent exercise, taking 
cold drinks while the body is warm and perspiring, etc. 

The eruption may appear suddenly during the night, 
and cover the entire body with its rose-colored patches, 
situated closely together, yet distinct. 

Roseola is divided into two groups. Idiopathic and 
Symptomatic. In the latter group the roseola occurs as 
an accidental phenomenon in the course of acute diseases, 
and hence is called symptomatic; in the other group it 
exists as the sole and primary disease. 

Idiopathic Group. — Roseola infajitilis is the name given 
to roseola when it is seen in infants. It roughly re- 
sembles measles minus the catarrh; it runs an ir- 
regular course as regards precursory symptoms, which 
vary in degree, and in the extent, degree, and seat of 
eruption. It may be quite general but patchy, or it may 
be limited to the arm, or the neck, or trunk; the rose- 
blushes often come and go for several days capriciously, 
and are accompanied by local heat and itching, which are 
often marked at night. No catarrhal symptoms, as in 
measles, are present. The redness generally lasts a 
dozen or more hours. 

When the disease assumes the form of rings (and this 
is generally observed about the buttocks, thighs, and 
abdomen), developed from little rose spots, and enclosing 
presently a healthy circle of skin an inch or so in diame- 
ter, the variety R. annulata is present. The concomi- 
tant symptoms are the same as those of the common form. 
It is not necessary to make all the varieties of roseola 
that are made by some authors. 

The Symptomatic Group contains roseolas which are 
merely rosy erythmata developed in the course of acute 
diseases, generally appearing about the arms, breast, and 



ROSEOLA. 81 

face, thence spreading over the body. R. vaccijiia co- 
exists with the formation of the vaccine vesicle, and is 
accompanied by slight fever. It commences around and 
about the seat of the vaccination. In cases of fevers, 
about the tenth day or so, and indeed whenever the 
weather is very warm, the perspiration is apt to distend 
the sweat glands, which become more or less hypersemic, 
so that little vesicles form, for example, miliaria and 
sudamina. Sometimes red blushes accompany this par- 
ticular kind of vesicular eruption, and to these rosy 
blushes the name R. miliaris has been given. 

After surgical operations a rash like scarlet fever very 
frequently occurs; its color varies somewhat; it is not 
contagious, and is without the general symptoms, the 
throat complication, hot skin, quick pulse, and tongue of 
scarlet fever. It is due, doubtless, to some volatile 
poison free in the blood. It has no gravity. 

The Prognosis offers no point of gravity or interest. 

The Diagnosis. — Roseola is likely to be confounded 
with rubeola, scarlatina, urticaria, erythema. It is 
known from measles, in that it possesses no catarrhal 
symptoms; in that there is no relation between the febrile 
symptoms and the amount of eruption; in that there is 
no epidemic influence at work in its production; in that it 
is irregular in its distribution, non-crescentric, not uni- 
form, not dark-colored; but irregular, rosy, and often 
commencing in other parts than the face. Rubeola has a 
regular course, and is not partial in regard to the distri- 
bution of its accompanying eruption. 

It makes very little difference if roseola be confounded 
with erythema, for the one is a red, the other is a rosy 
erythema. 

In Scarlatina, the general aspect of the disease is 
grave; the fever is marked, the throat is bad, the tongue 



82 SKIN DISEASES. 

is peculiar; the skin harsh, dry; the rash general, puncti- 
form, boiled-lobster like. The progress is more uniform, 
and the disease can be traced to contagious or epidemic 
influence. 

In Urticaria, the diagnosis is at once settled by the 
discovery or production of a wheal, and the peculiar 
stinging character of the local irritation, with the capri- 
cious character of the eruption. 

Treatment. — The benign and self-limiting nature of 
the disease leaves but little need for work under this 
head. The old-school advise giving salines, aperients, 
laxatives, etc , and treating any vSpecial symptoms. lyO- 
cally, in removing all causes of irritation — for example, 
irritated and tender gums, by lancing; acidity of stomach, 
by magnesia, soda, or lime-water; intestinal irritation, 
by "alteratives," such as rhubarb, and subsequently 
tonics, keeping up the warmth of the surface, and if pos- 
sible, bringing on perspiration. The surface should not be 
chilled. The patient should be kept within doors for a 
few days, and have a warm bath at bed-time, followed 
by cutaneous frictions with oil; the diet should be light 
and non-stimulating. 

Belladonna is the principal internal remedy. Ferrum 
phos. is highly recommended by some physicians. Large 
doses of antipyrine produce an erythematous eruption 
which is cinnabar-red in color, slightly elevated, and 
consists of rounded spots, disappearing under pressure. 
At the knees and elbows are found great red patches, 
chiefly on the extensor surface. The head, palmar and 
plantar surfaces are not affected. 

Urticaria. 

Urticaria is aa affection of the skin characterized by 
the development of white or reddish elevations termed 



URTICARIA. 83 

wheals, which are accompanied with more or less pruritus. 
These wheals may be few and localized, or, more fre- 
quently, they exist in considerable number, and are gen- 
eralized. 

Not infrequently a little heat and itching first appear; 
and, if the part be rubbed or scratched, the wheals be- 
come manifest. The elevations ma}^ last for a few min- 
utes only or for a few hours, and disappear, leaving no 
trace behind. Later in the day, or perhaps the next day, 
a renewal of the eruption occurs, and these may be re- 
peated for a few days or persist for months, constituting 
a chronic urticaria. 

The degree of pruritus varies; it may be hardly more 
than an agreeable sensation, or may be sufficiently severe 
to constitute a veritable torture. The scratching will, 
of course, be commensurate with the itching, and lead to 
more or less excoriation and even deep wounding of the 
skin. 

The wheals are chiefly met with on the covered por- 
tions of the body, and their appearance is favored by 
warmth' frequently disappearing if the parts be exposed 
to a draught of cold air. Thus it not infrequently hap- 
pens that a patient may have a severe attack at home, 
but, by the time he reaches the physician, all signs of 
the eruption will have disappeared, or perhaps there will 
be nothing visible on the skin except a few insignificant 
scratch marks. In these cases, if the finger nail or the 
point of a pencil be sharply drawn across the skin, it 
will be followed by a white line, which in a few moments 
becomes elevated and red, and lasts for a brief period, 
and then disappears. 

Urticaria presents certain peculiarities according as it 
occurs in the adult and the child, owing, in the latter, to 
the greater sensitiveness of the skin, and the tendency to 



84 SKIN DISEASES. 

the deposition of lymph in the site of the wheals. Some 
authors treat of urticaria in the adult and in the child. 
I think this is entirely unnecessary and apt to lead to 
confusion. 

The chronic forms may result from the acute, or de- 
velop out of a state of tolerable health, and without ap- 
parent cause. There is little pyrexia present in chronic 
urticaria. When the crops of wheals are of pretty long 
continuance, the disease is called U. perstans In other 
cases the wheals are small and very fugitive; but the 
skin is irritable, and the itching intense. This is U. 
evanida. The name oi factitious urticaria has been given 
to that form of the disease which is easily produced by 
mechanical irritation, and is not idiopathic. 

It occasionally happens that in the formation of wheals, 
instead of serum being poured out, a certain amount of 
hemorrhage occurs. This effusion of blood in con- 
nection with the escape of serosity from the vessels is 
not confined to urticaria, but may take place under cer- 
tain circumstances in connection with almost every skin 
affection which is hypersemic and inflammatory. When 
the effusion is conjoined with the development of wheals, 
the blood generally raises the cuticle somewhat, and pro- 
duces what is called purpura urtica7is. The cuticle some- 
times bursts, and exposes a reddened surface that does 
not heal, and whence a certain amount of bloody fluid 
may ooze for a while. The name of Urticaria hemorrhagica 
has been given to this latter disease, and it includes the 
so-called purpura urticans. The hemorrhage, however, 
is a mere epiphenomenon, though it indicates a purpuric 
tendency. These little hemorrhagic wheals are some- 
times seen about the neck and face of nervous women 
and elderly men out of health. 

Etiology. — In a person predisposed to this affection 



URTICARIA. 85 

almost any external irritation may cause an outbreak; and 
an exactlj" similar eruption may be provoked in some by 
contact with certain poisonous plants, as the common 
nettle. More frequently, however, the eruption is of in- 
ternal origin, and is but the reflection of pre-existing 
irritation of the gastro-intestinal or sexual organs. Cer- 
tain articles of diet — as crabs, lobsters, various shell-fish, 
and certain fruits — as well as certain medicinal agents, 
excite a gastro-intestinal derangement, which is chiefly 
made manifest through the cutaneous disturbance. 

Under the first head, or local excitants, rank the 
acarus, fleas, bugs, mosquitoes, lice, flannel, the contact 
of numerous other irritants, such as " jelly-fish." 

Prognosis. — There is no gravity attaching to urticaria. 
Acute attacks ab ingestis are of short duration. Chronic 
urticaria is very troublesome; the intermittent form is 
also very obstinate. 

Diagnosis. — Urticaria ought not to be confounded 
with any other disease. The sudden appearance of erup- 
tion and its capricious character, the tingling sensation, 
the presence of wheals, gastric disturbance, and irrita- 
bility of skin are absolutely diagnostic. 

Frankworsky urges flagellation of the skin with nettles 
as a very efficient remedy in anaesthesia, paralysis, and 
neuralgia. He has witnessed good effects from the same 
in locomotor ataxia. In asthma, dyspnoea, amenorrhoea, 
virile impotence, and rheumatic pains, it regulates the 
disordered functions. In favor of this procedure he cites 
the rapidity of its action, its innocuousness even after 
prolonged use, and the total absence of all irritation of 
the kidneys arising from it. It leaves no scars, and gives 
rise to no suppurating surfaces on the skin. The flagel- 
lation may be either local or general and should be con- 



86 SKIN DISEASES. 

tinned until bullae form. Its action is stimulating and 
refreshing. 

Treatment. — The principal consideration in the treat- 
ment is the diet, which should be light, nutritious, and 
easily digestible. To allay the itching the eruption may 
be frequently dusted with toasted rye or wheat flour, or 
when the cuticle is not broken it may be washed with 
brandy and water, or salt and water. Warm vinegar and 
water lotions may be used to allay the itching and burn- 
ing. Chloroform, one-half drachm to the ounce of 
cream, will frequently prove serviceable. Benzoic acid, 
grs. v-x, water gj. is spoken of favorably. A weak 
carbolic acid lotion at times acts well. The Turkish 
bath may help when other means fail. 

In acute cases, especially those in w^hich it is clear that 
the trouble has arisen from irritant ingesta, the indica- 
tions for treatment are clear, and should be promptly 
carried out. A good emetic, or a free purge, will clear 
out the alimentary canal, and, thus removing the cause 
of the irritation, bring the affection to a speedy close. 

In children, especially, the diet must be carefully regu- 
lated. In chronic cases, especially w^hen caused by eat- 
ing shell-fish, study Arsenicum ; in cases of gastric origin, 
consult Kreosotum, Bovista and Pulsatilla; in children 
who are fond of eating salt, Natrum mur,; candy eaters 
may be benefited by Argentum 7iitricu7yi. 

The indications for the homoeopathic remedies are as 
follows: 

Aconite. —Red and broad vesicles with itching, and 
feverish symptoms. Urticaria febrillis. Great heat, 
thirst, frequent pulse, malaise, sleeplessness; fear- or 
fright. 

Allium cepa. — Nettle-rash on the thighs with stitches 
and burnings. Acute catarrhal symptoms. 



URTICARIA. 87 

Anacardium. — Nettle-rash from emotional causes. Dull 
pressure as from a plug in various parts. Weakness of 
memory. 

A7itimon. cnid. — White blotches with red areolae, vio- 
lent burning and stinging. Blotches and vesicles, as from 
stings of insects, on the face and joints, coming on with 
itching and disappearing in a few hours. Thirst, nausea, 
thick white coated tongue, gastric derangement. 

Antimon. tart. — White lumps with red areolae, which 
itch; eruption comes and goes, makes him irritable, very 
hot and thirst}' ; worse after meals. 

Apis mel. — Red and inflamed raised patches of hives, 
with stinging and burning. Aggr. by heat, amel. b}^ cold 
water. Itching and appearance of blotches after scratching. 
Stinging burning over the whole body, passing off after 
sleeping soundly; sudden stinging sensation over the 
whole bod}^, with white and red spots in palm of hands, 
or arms and feet, on head and nape of neck; uterine 
catarrh; urine scanty and high colored. 

Ar7iica. — Itching wheals, relieved by scratching. 

Arsenicum alb. — Itch-like eruption. Wheals of a 
scarlet color on the face and neck, the size of a half- 
dollar. Obstinate cases, intense burning. Itching better 
from external heat; worse from cold or from scratching. 
Irritabilit}^ of the stomach 

Astacus Jitiv, — In chronic cases when other remedies 
fail. Cla}^ colored stools. 

Arum. — Dirty, yellow blotches on calves and legs 
with burning. Better in a warm room. Melancholy. In 
light-haired, scofulous subjects. 

A7itipyrin. — Dr. Nicot reports in full four cases, all 
occurring in young women who had since early childhood 
been subject to attacks of urticaria, in which alkaline 
treatment had utterly failed to produce any relief. In 



88 SKIN DISEASES. 

one of these the eruption appeared periodically each day 
and Dr. Nicot recommended the use of Ajitipyrin in seven 
and a half grain doses two or three hours before the ex- 
pected period of eruption. After four days of this treat- 
ment the eruption disappeared entirely and did not 
return. His other cases are somewhat similar to the 
above, with the exception that the periodic element was 
not so well marked. In very chronic cases the improve- 
ment was less marked than in recent cases, though even 
then the cure was progressive and continuous. 

A lady, 24, suffered for many years with recurring at- 
tacks of urticaria, from which she could obtain no relief. 
As an experiment she took Antipyri?i. One dose of five 
grains mitigated the discomfort at once and entirely dissi- 
pated the attack. These cures are in accordance with the 
law of the similars, inasmuch as urticaria has been noted 
after the exhibition of this drug. Some observers have 
noted a thick crop of urticaria involving the skin that is 
not protected by the clothing. Others have discovered 
swelling of the face and bod}'. A very common condi- 
tion produced by the drug is " erythema, scarlatina-like 
redness, with itching and urticaria." 

Belladonna. — Bright scarlet red elevated puffy spots, 
surrounded by a white border. Parts sensitive to the 
touch. After eating cabbage or sour-krout. 

Berberis. — Blotches like nettle rash on the shoulder and 
right arm, accompanied with burning and stinging. Mo- 
mentary cold sensation on the parts. Heartburn with 
soap-sud taste in mouth. 

Bryonia. — Nettle-rash with rheumatic pains from at- 
mospheric changes, with sleeplessness. Symptoms worse 
from motion and from exposure to the heat of the fire. 

Caladmm. — Nettle-rash on the chest alternating with 



URTICARIA. 89 

asthma. Itching and sudden, violent corrosive burning, 
often on small spots. Worse at night. 

Calcarea carb. — Chronic nettle-rash. White elevated 
hard nettle-rash which disappears in the cold air. Ele- 
vated red stripes on tibia, with severe itching and burn- 
ing after rubbing. Children inclined to grow fat. Dur- 
ing dentition. Symptoms aggr. by drinking milk. 
Acidity. 

Carbo veg. — Blotches on the calves of the legs, wrists 
and feet. Burning in various places on the skin at night 
in bed. Bloating of the abdomen after a meal Frequent 
eructations. In cachectic individuals, accompanying 
dyspepsia. 

Causticum. — Chronic nettlerash, coming out more fully 
in fresh air, with decided aggr. and itching from the 
heat of the bed. Rash on the thighs just above the 
knees. Worse during day, better during wet weather. 

Chloral. — Eruption on arms and legs, exactly like net- 
tlerash, in large raised wheals, with intense irritating, 
itching, oedematous swelling of face, cheeks, eyelids and 
ears, coming on suddenly from a chill, not from heat. 
Aggr. by the smallest quantity of wine, beer or spirits. 
In grain doses in obstinate cases. 

Cinchona. — Nettle-rash coming out after scratching. 
Frightful swelling of the face, forearms and hands in the 
morning. Debility after loss of animal fluids. Malarial 
complications. 

Cimicifuga. — Urticaria from menstrual or rheumatic 
disorders. Excessive muscular soreness. Brain feels 
too large for cranium. In nervous hysterical females. 

Cina. — White wheals surrounded by er3^thematous red- 
ness, first on the nose, then all over the body. From 
worms. 

Cocculus . —YL^iX^ blotches, surrounded by red areolae, 
7 



90 SKIN DISEASES. 

on the limbs, wrists and back of the fingers. Burning 
itching as from nettles. 

Conium. — Stinging like flea-bites, only one stitch at a 
time. Evanescent itching. 

Copaiva. — Urticaria, at first on the face, especially the 
forehead, then on the back of the hands, and finally in 
isolated patches all over the body. Large red blotches, 
with constipation and fever. Violent chills, headache, 
and general malaise; red, hot skin, nettle-rash all over 
the body, delirium, drowsiness, scanty urine, which is 
dark, with brick-dust sediment. Great restlessness. 

Condurango. — Chronic urticaria. Gastric pains, 
mostly at the cul-de-sac of the stomach. 

Cosmolme. — Its effects, when applied to the skin in 
cases of urticaria, eczema, psoriasis, herpes, and in nearly 
all cutaneous diseases in which the skin is dry and irri- 
table, is certainly very soothing and often curative. 

Dulcamara. — White blotches, with red areolae, on the 
arms and thighs, stinging and itching with burning after 
rubbing. After taking cold. Nettle-rash over the whole 
body without fever. Eruption preceding the menses. 
Griping pains in the bowels, with nausea and diarrhoea. 

Fagopyrum. — Sore, red blotches inducing scratching, 
which aggravates. Swelling, the size of a hen's ^%z^ on 
the neck and shoulder. Dreadful stinging itching. 

Graphites. — Red spots like flea-bites all over, espe- 
cially on the calves of the legs. Itching worse in the 
evening and at night. Skin dry, never perspires, and is 
inclined to crack. In females with disposition to delayed 
menstruation. 

Hepar. — Chronic nettle-rash on the fingers and hands. 
Burning and itching of the skin after scratching. 

Hypericum. — Eruption like nettle-rash on both hands 



URTICARIA. 91 

at 4 p. M. Crawling in the hands and feet, they felt 
fuzzy. 

Ig7iatia. — During chilly stage of intermittent fever. 
Frequent discharge of much watery urine. In nervous 
subjects. 

Kali carb. — Urticaria during menstruation. Worse in 
warm weather. In persons with dry skin, or who are 
inclined to pulmonary troubles. 

Lycopus. — Troublesome urticaria, especiall}'^ affecting 
the left forearm and right leg, before eating. 

Lycopodium. — Itching with nettle-rash eruption on the 
extremities. Desire to eat, but a small quantity of food 
fills him up. Inclined to constipation. Urticaria from 
eating oysters, or shell-fish. 

Magnesia cai^b. — Hard blotches as if from nettle-sting, 
worse during menstruation. Menstrual flow more pro- 
fuse at night. 

Mercurius. — Small flat light red blotches on the 
sexual parts, abdomen, chest and inner side of the thighs. 
Easy perspiration without relief. 

Natrum mur. — White blotches on the arms and hands, 
turning red on scratching. Red blotches over the whole 
body. Violent itching. 

A^iix vom. — When accompanied by constipation, vertigo 
and headache. 

Podophyllum. — Intolerable itching of the skin on the 
body and arms; on scratching it raises up in blotches like 
hives. 

Psorinum. — After suppressed itch, frequent attacks 
of urticaria, with fine vesicles on the top which dry and 
peel off in fine scales. Coming on after any exertion. 

Pulsatilla nig. — Red, hot spots like nettle-rash. After 
eating fat pork, fruits or buckwheat. 

Pulsatilla nut. — Blotches on the right breast, standing 



92 SKIN DISEASES. 

out like measles, with red base, turning white on scratch- 
ing. Violent itching, worse at night before bed time. 

Rhus tox, — Vesicular urticaria from getting wet, dur- 
ing the rheumatism, with ch Us and fever, worse in cold 
air. Rheumatic pains worse at rest. Skin swollen and 
red; itching all over, worse on hairy parts, burning after 
scratching. 

Robinia. — Burning itching wherever a part of the face 
is touched. Itching of skin where anything rests upon 
it. Sour stomach. 

Sarsaparilla. — Blotches as from nettles. Burning 
itching with chilliness after abuse of mercury. 

Sepia, — Chronic form. Red, lentil-sized blotches on 
the hands. Eruption breaks out in the open air and dis- 
appears in a warm room, especially on the face, arms, 
and thorax. After milk and pork. 

Solanum oler. — Urticaria febrilis. 

Spigelia, — Small elevations like hives on the lower 
extremities after scratchiyig. 

Stannum. — Small, itching hives below the waist 
through the day. Itching aggravated by rubbing. In 
patients with phthisis. 

Sulphur. — Eruption, itching and burning over the 
whole body, with febrile symptoms, or when the indi- 
cated remedy does not act well. Itching aggravated by 
the warmth of the bed. Chronic cases. 

Tetradymite. — Nettle-rash on face after eating crabs. 

Trio steum p erf . — Nettle-rash with gastric derangement. 

Urtica urens. — Nettle-rash attending or preceding 
rheumatism. Itching swellings all over the fingers. Ag- 
gravated every year at the same time. Itching and 
burning of the skin, as if scorched; raised red blotches; 
fine stinging points; pale rash requiring constant rubbing; 
consequences of suppressed nettle-rash; eruption and 



FOLLICULAR HYPEREMIA. 93 

itching disappear as soon as she lays down and re-appear 
immediately after rising. 

Ustilago. — Terrible itching at night; menstrual irregu- 
larities from ovarian irritation. During the climaxis. 

Veratrum alb. — Nettle-rash, about the joints only. 

Zincum met. — Stinging itching in the skin with nettle- 
rash eruption after rubbing. Itching rash in hollows of 
the knees and bends of the elbows. After moderate wine 
drinking. 

The following case, reported by Dr. Hoyne, is very in- 
structive: Female, complained of itching all over the 
body, but especially bad upon the back. No eruption 
was to be seen, but writing a word upon her arm it stood 
out in blazing red a moment or two afterward, a certain 
diagnostic sign of urticaria. Her other symptoms were: 
Urine quite scanty but clear, and of good color; no appe- 
tite of consequence; meat does not agree with her; sour 
things disagree; drinks a large quantity of water daily; 
her limbs swell, principally about the ankles; dreams 
frequently and they are decidedly unpleasant; alternate 
constipation and diarrhoea; nearly every morning she has 
nausea and dizziness; shortness of breath when lying 
down, especially on her back. The urine, on examina- 
tion, showed no disease of the kidney. She received 
Apis, and in three weeks was entirely relieved of all her 
symptoms. 

Follicular Hypersemia. 

Hyperaemia of the follicles of the skin is often con- 
founded with diseases which it complicates, and it is im- 
portant that this accident common to many dissimilar dis- 
eases and its true significance should be distinctly under- 
stood in relation especially to the matter of general diag- 
nosis. 



94 SKIN DISEASES. 

Whenever the skin is much irritated, and particularly 
if scratching is practiced for the relief of itching, the 
follicles are apt to become congested. The result is that 
red hypersemic papules are formed by erection and 
turgescence of the upper part of the follicular walls. If 
the hyperaemia persists long enough a certain amount of 
hypertrophous growth may take place as a consequence 
of the hyperaemia, and solid papules may then form at 
the hair follicles which may from being scratched be- 
come covered at the apex with scales of dried blood that 
has been effused from the excoriations; in fact, the 
papules become pruriginous. But this is only a secondary 
result, not a primary condition. This accident of fol- 
licular congestion is found in a variety of diseases, and 
must be carefully distinguished from primary mischief, 
though in itself it indicates an excessive irritation of the 
skin. It is, in fact, the sign of a " scratched skin," and 
should be always recognized as such. 

Medicinal Rashes, or Eruptions, The Direct Result 
of the Action of Drugs. 

It is important that the homoeopathic dermatologist 
should be fully acquainted with the eruptions of the skin 
produced by the administration of medicinal substances. 
Many of our remedies are capable of producing some 
form of an eruption upon the skin , and it is this fact, or 
rather a knowledge of the action of these different 
medicinal substances, that enables the homoeopathic 
physician to prescribe successfully for many cases that 
the old school relegate to hygiene and time for a cure. 

As the therapeutic indications in the various lesions of 
the skin are but a history of the effects produced upon 
the healthy skin, in the prover, of the different medi- 
cines mentioned, no attempt will be made here to enumer- 



MEDICINAL RASHES. 95 

ate them. I shall, however, at the close of the volume, 
give the ' ' skin symptoms ' ' of some of the newer rem- 
edies, as all may not be so familiar with these as with the 
older remedies. 

Occasionally we find a case that will not respond favor- 
ably to any one of our old-tried friends, and some one of 
the newer remedies will prove to be the more exact sim- 
ilimum, and prove a grateful blessing to our patient. 



CHAPTER VI. 



THE ERUPTIONS OF ACUTE SPECIFIC 
DISEASES (ZYMOTIC). 

Which Ark of Contagious Nature, of Definite 
Course and Duration, Accompanied by Fever, 
THE Result of Poisoning of the Blood by 
Special Viruses — One of the Effects 
OF THIS Poisoning Being the De- 
velopment OF Certain Char- 
acteristic Eruptions on 
THE Skin. 

After considerable weighing of the question as to 
whether it were better to take up these affections or not, 
I have decided to give, for diagnostic purposes, a short 
description of this class of diseases, more especially of the 
eruptions. 

Variola. 

The eruption on the skin is characterized by the ap- 
pearance of bright, red, hard acuminated points, the size 
of hemp-seeds, distinct from each other at first, and 
which, passing through the stages of vesicular and pustu- 
lar inflammation, arrive at their maturity on the eighth 
day of eruption. The individual pustules then scab, 
their contents drying into brown masses which become 
detached in from twelve to fifteen days, and leave behind 
in their place permanent cicatrices, or ' ' pits. ' ' Variola 



VARIOLA. 97 

is often preceded, as regards its local state, by more or 
less erythema, which subsides on the appearance of the 
vari. This has been termed erythema variolosa. Variola 
is said to be discrete, when the pustules are scattered over 
the surface; coherent, when the eruption is plentiful, and 
the vari are ** closely packed side by side but still dis- 
tinct ; " confluent, when they run together; modified, 
when the disease succeeds to a prior attack or occurs 
after inoculation. Variola is, by universal consent, 
divided into five stages: Incubation, which is reckoned 
by the length of time which elapses between exposure to 
the poison of the disease and the development of the 
first effects (from five to twent}^ days); Invasion (two 
days); Eruption; Suppuration; Dessication. 

The ''Period of E7mption " — Eruption makes its ap- 
pearance on the third day after the first occurrence of 
constitutional disturbance, and travels over the entire 
body within a day, when the febrile condition is greatly 
relieved. 

There are exceptions to this when the rash appears on 
the second, fourth, fifth or sixth day. Should the erup- 
tion appear on the second day, the attack will be severe 
and the disease of the confluent variety ; if on the fourth 
day or later it will be unusually mild and of the discrete 
variety. 

The spots appear first on the face, about the forehead, 
and thence they extend to the trunk and limbs. These 
spots are, in the very outset, small papules, red, hard, 
and pointed, and their more or less closely packed or 
scattered condition affords a good guide as to whether 
the disease will be confluent or not ; if the skin be very 
red and erythematous, probably the case will assume the 
confluent form. On the second day of eruption — fourth 
of disease — the papules formed from elevation of the 



98 SKIN DISEASES. 

epidermis by an increase of the cells of the Malpighian 
layer and distension of the vessels in the true skin, but 
particularly the papillary layer, are transformed into 
vesicles. If these vesicles be punctured, nothing escapes 
from the puncture. On the third day of eruption — fifth 
of disease — umbilication commences as a central depres- 
sion, which becomes more marked every day, pari passu 
with suppuration, which now commences ; the pustules 
are " whitish and surrounded by an inflamed areola ;" the 
fourth day of eruption. If the contents are now turned 
out, a little " disc " of dirty plastic matter, presenting an 
umbilicated shape, and attached to the cutis beneath, will 
be noticed. It is not at all unusual to observe the con- 
fluent in one, the discrete form in another part of the 
same subject. The onset of maturation is observed about 
the end of the fifth or beginning of the sixth day of erup- 
tion, or the eighth of disease. The contents of the 
umbiHcated vesicles soften down into pus, the umbilication 
diminishing with enlargement of the base of the pustule, 
and a yellow color replacing the white. 

The stage of eruption, lasting about five days, is char- 
acterized by the cessation or at least by a remission of the 
febrile and other symptoms, which is not true of the 
other eruptive fevers. The temperature which has been 
104° to 106° falls to 100°, the pulse ranging from no to 
130 falls to 70 or 90 — in fact, the patient may feel per- 
fectly well. These diagnostic symptoms may be wanting 
if the disease proves to be of the confluent variety. 

Maturation, as it is called, is complete on the eighth 
day of eruption; between the eighth and eleventh day, 
secondary fever sets in, when the stage of dessication is 
reached. This is the period of recovery or resolution, 
when the local and general symptoms subside, the scab- 
bing dries, and the discharge ceases. The crusts fall off 



VARIOLA. 99 

i|i the next three or four daj^s, exposing raw, red sur- 
faces, which desquamate, and b3'-and-by leave behind 
red-looking marks, which gradually fade and assume the 
well-known aspect of small-pox marks. 

Itching of the skin to a greater or less extent persists 
during the whole course of the eruption. The rash also 
appears on the mucous membrane of the mouth and 
throat at the same time, presenting the appearance of 
round opaque spots, which are situated mainly on the 
tongue and soft palate, but are not by any means confined 
to these parts, for in many instances the rash appears in 
the larynx, trachea, bronchi or nostril, upon the mucous 
membrane of the vulva, prepuce, etc., with resultant laryn- 
gitis, bronchitis, etc. Or the eruption may take place in 
the e5^e and as a consequence lead to destruction of the 
sight; in the tunica vaginalis, giving rise to variolous 
orchitis; upon the peritoneum surrounding the ovaries, giv- 
ing rise to variolous ovaritis. Orchitis is more frequently 
met with than ovaritis. The eruption upon the mucous 
surface gives rise to considerable discomfort, for these 
ulcerated spots are as tender to the touch as ulcers in 
other situations. 

When variola is produced by inoculation there are 
some differences. On the third day the puncture is in- 
flamed, it is itch}^, and surrounded by a little blush of 
redness, whilst the spot is slightly indurated; on the 
fourth or fifth day the central point acuminates, and a 
little coming vesicle is seen; on the sixth day there is an 
early state of pustule, and it is umbilicated; on the 
seventh day a perfect pustule is formed with an inflamed 
areola; on the ninth or tenth day, maturation takes place, 
and the umbilication of the pustules goes; from the 
twelfth to the fifteenth day desiccation takes place, and 



100 SKIN DISEASES. 

from the twentieth to twenty-fifth day the scab falls off. 
The disease is rarely confluent. 

The fever, which had subsided or entirely disappeared, 
returns during the stage of suppuration. The tempera- 
ture rises to io6° to io8°, the pulse runs up to no to 
140 or higher, the thirst is urgent and there are no longer 
perspirations of any sort. This secondary or ** suppura- 
tive ' ' fever terminates in a few days in the discrete 
variety if there are no serious complications, but in the 
confluent it is somewhat prolonged. 

Bach pustule has an inflammatory areola of considera- 
ble extent. The face especially becomes greatly swollen — 
oedematous. In the confluent variet}^ this cedematous 
swelling is frequently sufficient to completely close the 
eyes. The hands and feet are likewise swollen and burn 
like fire. As a consequence of the eruption in the mouth 
and throat a free and copious flow of saliva is to be 
expected. The glands and subcutaneous tissues of the 
neck become enlarged in many cases. 

Hemorrhagic variola commences very much like the 
other varieties, but there is a marked coldness of the ex- 
tremities followed by a deep purpHsh redness of the sur- 
face. The eruption at first shows a very deep red color, 
and when the vesicles appear they are of a bluish-black 
color; in other words, they are filled with blood. At the 
same time ecchymosed spots, resembling bruises, are seen 
more or less over the entire surface and in the conjunc- 
tivae of the eye. The patient expectorates blood, vomits 
blood, passes blood with the stool and urine — there is a 
flow of blood from every outlet of the body. Recovery 
is very rare, and death may take place at any stage, but 
usually before the pustules form. 

I have never had to treat a case of this form, but from 
a comparison of the symptoms as above given would 



VARIOLA. 101 

recommend the employment of two remedies internally — 
Crotalus hor. and Phosphorus, 

To prevent pitting lard and charcoal may be used, or 
the face may be painted with sweet cream; the object be- 
ing to exclude light and air. Various expedients have 
been recommended, but they all fail in the majority of 
cases. 

The advice of the dermatologist is not infrequently 
sought for the removal of certain disfiguring conse- 
quences of variola about the body. 

In the first place redness of the face has to be dealt 
with therapeutically. This may be rendered much less 
visible by the use of some mild astringent, but the great- 
est care must be taken to avoid every application which 
could in any degree increase by stimulation the hyper- 
semia. The following makes a very excellent prepara- 
tion : 

^. Oxide of Zinc, ^jj. 
Calamine powder, gss. 
Glycerine, ^jj. 
Rose water, S^jjj- 

It should be used after bathing with hot water, being 
dabbed in and allowed to dry. Scarring cannot in the 
nature of things be prevented. If the scars become 
the seat of hypertrophous growth of cicatricial tissue the 
knife must not be used, but the frequent application of 
contractile collodion had recourse to. It should be ap- 
plied twice a day for some time. Acne spots may also 
develop about the nose, for which the ordinary treatment 
for acne should be employed. 

The indications for remedies are as follows: 
Aco7iite. — During the febrile stage at the beginning, 
headache, epistaxis, injected eyes and frequent pulse. 



102 SKIN DISEASES. 

Anxious restlessness. Pain in the back and aching in 
the limbs. Apprehension of a fatal issue. Excessive 
thirst. 

A?nmo?i. carb. — Hemorrhagic diathesis, from fluidity 
of blood and dissolution of red blood-corpuscles; ten- 
dency to gangrenous ulcerations. 

Ammon. inur. — Eruption well developed upon trunk 
and upper extremities, but scanty on lower ones; sore 
throat, with swelling about neck; hemorrhages. 

Antimon. crud. — Gastric state, with vomiting and 
heavily coated tongue, especially during prodromal 
stage. 

Apis mel. — Erysipelatous redness and swelling, with 
stinging, burning pains in skin and throat; absence of 
thirst; scanty micturition; at a later period great 
dyspnoea; sensation as though he would not be able to 
breathe again; great restlessness; suppression of urinary 
secretion. 

y4r^(??2zV. ^Asthenic cases, with great sinking of 
strength; burning heat; frequent small pulse; great 
thirst; great restlessness; irregularly developed variola, 
with typhoid tendency; hemorrhagic variola, or when 
the pustules sink in and their areolae grow livid; metas- 
tasis to mouth and throat in last part of eruptive period. 

Baptisia. — Typhoid symptoms; fetid breath; pustules 
appear thickly upon palatine arch, tonsils, uvula, and in 
nasal cavities, but scantily upon skin; profuse salivation; 
great prostration, with excessive pains in sacral region. 
After taking the drug appetite improves and the patient 
is able to take and to retain nourishment. 

Belladonna. — During first stage, high fever with cere- 
bral congestion ; intense swelling of skin and of mucous 
membranes, with tickling cough, dysuria, and tenesmus 
of bladder ; sleeplessness, with desire to sleep ; delirium 



VARIOLA. 103 

and convulsions ; photophobia ; ophthalmia. During 
later stages Belladonna modifies the itching of the desic- 
cating pustules. 

Bryonia. — Brings out the eruption when it is dela3^ed, 
or when it suddenly disappears. In the first stage with 
gastric symptoms, or after the eruption is out, if ascites 
sets in, very cross and irritable ; wants to lie still ; dry 
mouth without thirst, or else w^ants large quantities at 
long intervals. Constipation of hard, dry stools. 

Caniphora. — Sudden collapse, with coldness of the 
surface ; the swelling of the skin suddenh^ sinks in, and 
the pustules seem to dry up, from the complete giving out 
of the life forces ; excessive weakness ; the patient, 
though cold, cannot bear to be covered. 

Calcarea sidph. — Pustules discharging matter. 

Cantharis. — Hemorrhagic state ; patient passes bloody 
urine, with cutting burning pains ; burning pains through 
whole intestinal canal, wdth unquenchable thirst and 
disgust for all kinds of drinks. 

Carbolic acid. — Dr. Middleton believes this drug to be 
as near a specific for variola as it is possible for any 
drug to be for any disease, and even in the hemorrhagic 
variety, if used early, there wnll be greater prospects of 
recovery than with any other drug knowm. He employs 
the IX. When given at an early stage of the disease, 
Dr. Montefero has found that the pustules fail to de- 
velop ; they shrink and dr}^ up after a few days without 
an}^ swelling of the subcutaneous tissue. In the sup- 
purative stage it moderates the fever, and lessens the suf- 
fering in the mouth and phar3mx. The urine turns black 
when standing, and in some cases shows some traces of 
albumin. 

Carbo veg. — Asthenic variola, with cold breath and 



104 SKIN DISEASES. 

excessive prostration ; great desire for fresh air ; livid 
purple look of the eruptions ; hippocratic face. 

Chamomilla. Great fretfulness of children during 
eruptive stage, with the usual impatience and coldness. 

China. — Variola hemorrhagica, with great exhaustion 
from the copious painful stools ; excessive debility and 
prostration after a severe attack. 

Cimicifuga. — In the precursory stage, for the muscular 
rheumatoid pains ; during eruptive fever great wakeful- 
ness, mental excitement as if the brain would burst out ; 
dull heavy aching in small of back, relieved by rest, in- 
creased by motion ; excessive muscular soreness ; prick- 
ling itching heat of the whole surface ; eruption of white 
pustules over face and neck ; it modifies the disease, pre- 
vents the development of pustules, and thus reduces the 
danger of pitting. 

Coffea. — Restlessness and bilious vomiting at the com- 
mencement of the disease. 

Cupru77i. — Convulsions preceding the eruption; vomit- 
ing, delirium, sopor. 

Ferrum. — Fiery redness of the face after recovery. 

Gelsemium. — Predominance of nervous symptoms, as 
nervous chills, restlessness ; intense and painful fever at 
the commencement of disease, with tendency to con- 
vulsions. 

Hamamelis. — Hemorrhagic variola ; blood dark, ve- 
nous ; oozing of dark blood from nose ; bleeding gums, 
hematemesis, bloody stools ; uterine hemorrhage, pete- 
chise ; tearing pains across the small of back, with ful- 
ness of the joints of the legs; typhoid condition. (If 
Ham. fails, try Crotalus horr.). 

Hepar.—hoosQ, rattling cough, without expectoration ; 
suppurative stage ; swelling and suppuration of the 
glands. 



VARIOLA. 105 

Hydrastis. — Itching tingling of eruption, face swollen, 
throat sore, pustules dark, great prostration ; buccal 
cavity full of pustules ; pulse slow and labored, with 
palpitation of heart ; intense aching pain in small of back, 
legs feel very weak and ache ; is said to prevent- pitting 
to a great degree. 

Hyoscyamus. — Eruption fails to appear at the proper 
time, causing great nervous excitement, with rage, 
anguish, delirium, coming on in paroxysms; patient 
wants constantly to get out of bed and to be uncovered 
(hyperaesthesia of skin); vesicles coming out in crops; 
restless sleep; slight fever; dry teasing cough, relieved 
by sitting up. 

Ipecac. — Gastricismus during eruptive stage, with con- 
stant nausea. 

Kali ntur. — Controls the formation of pustules. 

Kali phos. — Putrid conditions, heavy odor, exhaustion 
and stupor. iVdynamic symptoms indicating blood de- 
composition. 

Kcili sulph. — To promote the formation of healthy 
skin and the falling off of the crusts, 

Melandrinum 30X was used during the epidemic of 
1 880-1 with great success as a preventive as well as a 
curative agent. It prevented the suppurative fever, or 
lessened it at least to a considerable degree, and took 
away all offensive exhalation. 

Mercurius. — Variola in the stage of maturation; 
ptyalism; tendency of blood to head; irritation of mu- 
cous membranes; moist swollen tongue, with great thirst; 
diarrhoea or dysentery, with tenesmus, especially during 
the period of desiccation. 

Natrum mur. — Salivary flow, confluence of pustules 
and drowsiness. 

Opium. — Drowsiness and stertorous breathing. Com- 



106 SKIN DISEASES. 

plete loss of consciousness. Impending paralysis of the 
brain. 

Phosphorus. — Hemorrhagic diathesis; bloodj^ pustules; 
hard, dry, exhausting cough, with pain or feeling of raw- 
ness in chest; bronchitis; hemorrhage from lungs; back 
pains as if broken, impeding all motion; frequent faint- 
ings; typhoid variola, even so from the start. 

Phosphoric acid. — Confluent variola, with typhoid con- 
ditions; pustules do not fill with pus, but degenerate into 
large blisters, which, bursting, leave an excoriated sur- 
face; patient is stupid, does not want anything, not even 
a drink; answers questions, but does not talk otherwise; 
subsultus tendinum, great restlessness; fear of death; 
watery diarrhoea. 

Rhus tox. — Typhoid symptoms, dry tongue; great rest- 
lessness; patient wants to get out of bed, notwithstanding 
his great debility; sordes on lips and teeth; confluent 
smallpox, with great swelling at first, but afterwards the 
eruption shrinks and becomes livid; blood in pustules; 
bloody stools. 

Sarracenia. — From reports, the consensus of opinion 
seems to be in favor of this plant in the treatment of 
severe cases of variola; there are no reliable indications 
as yet. 

Silicea. — Suppurative stage exhausts the strength of 
patient and desiccation is delayed; caries of bones, fol- 
lowing severe attacks of variola, with fistulous openings 
and discharge of thin pus and bony fragments. 

Solatium nig. — Hemorrhagic variola. 

Stramonium. — Entire swelling of the face before the 
eruption, with muttering delirium. 

Sulphur. — Tendency to metastasis to the brain during 
suppuration; stage of desiccation; occasionally indispen- 
sable as an intercurrent remedy, where others fail. 



VARICELLA. 107 

Tartarus e7net. — Eruption tardy in coming out, with 
great oppression under sternum, nausea, vomiting, sleep- 
iness, or for suppression of eruption; putrid variola, 
with typhoid symptoms, especially typhoid pneumonia, 
with tendency to paralysis of lungs; vomiting of viscid 
mucus, clogging the air-passages; pustules in larynx, 
mouth, throat, and digestive organs; leaving bluish-red 
marks on face, genitals, and thighs. 

Vaccininum has been used undoubtedly with great 
benefit in variola; its use has shortened and ameliorated 
all stages quite considerably. Sulphur was given after- 
wards. 

Variolinum. — Especially where the disease throws 
itself with full force on throat. Given steadily during 
the disease it will run a milder course, changing imper- 
fect pustules into regular ones, which soon dry up; it 
promotes suppuration, and desiccation, and prevents pit- 
ting. 

Veratfum vir. — Intense fever, with excessive pain and 
restlessness. Used in alternation with Macrothi the pus- 
tules flattened rapidly, dried, and fell off. 

Varicella. 

This is a disease of childhood. After pyrexia lasting 
a few hours, or not more than a day, the eruption of 
varicella appears, often on the back first of all, as distinct 
red papulae, which become vesicular in a few hours; the 
eruption is successive during three or four days. The 
same kind of changes occur in the eruption as in variola, 
but the disease is more superficial, and the vesicle is uni- 
locular, and it is not generally umbilicated: the con- 
tents are serous rather than puriform. On the first 
day the vesicles are transparent; opalescent on the second 
and third; on the fourth they shrink and desiccate; and 



108 SKIN DISEASES. 

on the sixth the scabs fall off. Sometimes, however, the 
contents of the vesicles become puriform. The general 
pyrexia is slight. 

The prognosis is favorable. If the fever runs high 
with much disturbance of the system, the patient may 
require one of the following remedies: Aeon., Bell., 
Mere., Rhus, Tart, emet., or Verat. v. 

Typhus Rash. 

This consists of two component parts: 

1. A subcutaneous mottling, of ^ more or less livid 
hue, and diffused generally over the body. 

2. Petechise, small, about the size of pin's heads, scat- 
tered all over the body, and showing out from the mot- 
tling; at first these are slightly raised, and their color 
increases gradually in intensity; they do not fade by 
pressure, except slightly in the very early stages. The 
eruption of typhus is not prolonged by successive crops. 
It makes its appearance between the fifth and eighth day 
of disease, and disappears a few days before convalescence. 
It has been mistaken for syphilitic rash. 

Typhoid Rash. 

. Is characterized by the appearance between the eighth 
and twelfth day of disease of rose-colored, elevated, cir- 
cular, softish spots, about a line of so in diameter, on the 
abdomen, back of hand, arms, chest, and back (if kept 
warm). These rose-colored spots disappear by pressure, 
and they appear in successive crops, each spot lasting 
three or four days, and then gradually fading. There 
may be from half a dozen to a score of these spots present 
at one and the same time. Sudamina often co-exist with 
them. 



MEASLES. 109 



Measles. 



Within fourteen days from the reception of the con- 
tagion, the eruption of measles appears, the first stage, 
the stage of invasion, consisting of a catarrhal attack 
upon the head and chest. The child is restless and 
feverish with headache. The eyes grow red, weak and 
watery, unable to bear the light. There is frequent 
sneezing, with water}^ discharge from the nose and a 
constant short, dry and sometimes croupy cough. In ex- 
ceptional cases there may be vomiting and delirium. 
About the fourth day, the stage of eruption comes 
on, the rash appearing first on the face and extending in 
the course of 48 hours over the body. About the third 
day of the disease the rash may be observed on the fauces. 
The eruption consists of numerous deep red circular spots 
resembling flea-bites. Between these spots the skin re- 
tains its normal color, except upon the face, where it 
may be oedematously swollen. On the cheeks the rash 
sometimes becomes confluent, forming blotches and pre- 
senting a crescentic shape. In the same order as it came 
on the rash fades, beginning to grow faint on- the face 
when it is at its height on the body. In this stage the 
fever increases, the temperature rising to 102° to 106°. 
The third stage, the stage of desquamation, begins about 
the eighth or ninth day of the disease, when the rash dis- 
appears and the epidermis peels off in fine scales. This is 
the course of the normal type, but in some cases the onset 
of the disease is so violent that the child dies in the 
second stage from asthenia with t3^phoid symptoms. In 
other cases, inflammatory measles, the rash grows darker, 
assumes a purple color, remaining visible for some days, 
and all the symptoms are intensified. The cough be- 
comes croupy and there may be lobular pneumonia. This 



110 SKIN DISEASES. 

runs to exhaustion, with disappearance of the eruption 
and collapse The sequelae of measles are chronic 
catarrhal cough and chronic pneumonia, which may end 
in consumption, also scrofulous affections, chronic inflam- 
mation of the eyes, otorrhoea, swelling of the glands. 

In the treatment of measles, the bedroom should be 
kept at an equal temperature of about 65° and aired fre- 
quently with care. The light regulated to the eyes of 
the invalid. The diet light, with ripe fruit in season, if 
the bowels are not disordered. After the disappearance 
of the fever and catarrhal symptoms a warm bath may 
be given, with another on the following day, with thor- 
ough rubbing and friction of the skin afterward ; after 
which, if the weather is favorable, the patient may be 
allowed to go out. 

Therapeutic Indications. 

Aconite. — In the beginning, with dry, hot skin, full, 
frequent pulse, thirst, red, watery eyes with photophobia. 
Stitching pain in side and chest. Dry, hacking and 
croupy cough. Catarrhal irritation. Anxious restless- 
ness. Vertigo on raising up. 

Antimon. crud. — White- coated tongue. Gastric de- 
rangements. Pain in the ears. 

Apis. — Confluent eruption and oedematous swelling of 
the skin. Cough and soreness of the chest, as if bruised. 
Violent cough similar to whooping cough. Catarrh of 
the bowels, diarrhoea in the morning, stools greenish- 
yellow. Scanty, high-colored urine. Oppression of the 
chest and inability to remain in a warm room. 

Arsenic. — Malignant cases with typhoid symptoms. 
Eruption dark colored or retroceding. Pale, earthy face. 
Great dryness, burning and itching of the skin. Rapid 
prostration. Intense thirst, but drinks ovXy small quanti- 



THERAPEUTIC INDICATIONS. Ill 

ties. Anxiety and great restlessness. Thrush in the 
mouth and on the fauces. Worse about midnight. 

Belladonna. — In the commencement with hot, moist 
skin, and frequent soft pulse. Congestion to the head. 
Constant drows}' sleep or drowsiness with inability to 
sleep. Bright redness of the throat, with pain on swal- 
lowing. Diphtheritic symptoms. Back feels as if it 
would break. Thick, white-coated tongue. Worse 
about three o'clock a. m. Complication with scarlet 
fever. 

B?yonia. — Eruption does not come out well. Con- 
gestion to the chest with stitching, shooting pains on 
breathing or motion. Rheumatic pains in the limbs. 
Great dyspnoea and hurried breathing. Dry mouth 
without thirst or thirst for large quantities at long inter- 
vals. Better from warm drinks. Children grasp the 
cup with both hands. 

Camphor a. — Vital depression. Face pale, skin cold 
and blue, inclination to uncover. Eruption does not 
come out. Various sequelae, particularh^ difficult and 
painful micturition. 

Carbo veg. — Persistent hoarseness after measles. 

Chamojnilla. — Great restlessness, child w^ants to be 
carried. Very cross and fretful. Painful, watery diarrhoea. 

China. — Violent colic, with unquenchable thirst. Ab- 
dominal ailments with frequent stool. Debility and no 
fever. 

Coffea. — Nervous, restless agitation, preventing sleep. 
Dry, hacking cough, with constant tickling in the larynx. 

Cupruin acet. — Measles, bronchitis, delirium, wants to 
go home. Expectoration onl}- during the night. On 
falling asleep, begins to talk, scold, turn, twist and 
scream ; on being aroused, was perfectly rational ; tongue 
and mouth red. 



112 SKIN DISEASES. 

Drosera. — Cough, like whooping cough, or hollow, 
barking cough. 

Dulcamara. — Retrocession of the eruption from ex- 
posure to cold, damp air. 

Euphrasia. — Profuse, bland discharge from the nose, 
and of acrid running from the eyes, with photophobia. 
Cough only during the day. 

Ferriim phos. — Measles in all stages, especially in the 
initiatory and prodromic, also for the symptoms of in- 
flammatory affections of the chest, eyes, or nose, or ears. 

Gelsejnium. — After Aconite, great deal of coryza ; 
drowsy with fever heat, no thirst. When the eruption 
turns livid, with cerebral symptoms. Rawness of the 
chest, with cough. 

Hepar sulph. — Croupy cough, with rattling in the 
chest, but without expectoration, worse in the morning. 

Ipecac. — Eruption slow to appear, with oppression of 
the chest. Constant tickling cough with every breath 
and rattling of phlegm. Constant nausea and uneasiness 
in the stomach. 

Kali bichrom. — Cough, with rawness of the chest. 
Pustule on the cornea. Stitches in the left ear extend- 
ing into the neck and head. Running of water from the 
eyes, with burning when opening them. Watery dis- 
charge from the nose, with great sensitiveness and ulcera- 
tion of the nose. Loud rattling cough with tough, stringy 
expectoration. 

Kalimur. — For the hoarse cough, for all the glandular 
swellings and the furred tongue, with white or gray de- 
posit, it is a remedy of prime importance. For the after- 
effects of measles. Diarrhoea, whitish or light-colored, 
loose stools, white tongue. Deafness from swelling in 
the throat, etc. 

Kali sulph. — Suppressed rash, rash suddenly recedes 



THERAPEUTIC INDICATIONS. 113 

with harsh and dry skin. This remedy will assist the 
returning of the rash. 

Mercurius. — Swelling of the glands of the throat, and 
difficult swallowing. Soreness of the throat and ulcera- 
tion of the tonsils. Profuse secretion of saliva and fetid 
breath. Pit of the stomach very sensitive. Profuse 
sweat without relief. 

Nux vom. — Nose stopped. Cough dry in the evening 
and loose in the morning. 

Phosphorus. — In complication with pneumonia, or ty- 
phoid symptoms come on. Violent exhaustive cough 
with tightness across the chest. Dry cough with vomit- 
ing. Hoarseness, and aphonia. Stitching pains in the 
chest, worse from coughing or breathing. 

Pulsatilla. — Inflammation of the eyes and photophobia; 
thick, yellow discharge from the nose; dryness of the 
mouth, without thirst; nightly diarrhoea, after previous 
rumbling in the bowels; rattHng, loose cough, with ex- 
pectoration of thick, yellow mucus; increase of all the 
symptoms towards evening; chronic, loose cough after 
measles." 

Stida pubn. — Incessant dry or spasmodic cough, worse 
in the evening and during the night, with oppression of 
the chest and feeling as if a hard mass had collected 
there. 

Stramonium. — Sometimes before the eruption there is 
delirium with frightful visions of rats and mice, from 
which the patient tries to hide. Spasmodic sj^mptoms in 
the phar3mx and difficulty of swallowing. 

Sulphur. — The eruption does not come out and the ca- 
tarrh becomes continually worse. Violent otalgia with 
purulent discharge. Chronic after complaints, otorrhoea, 
diarrhoea. 

Ve7'at. alb. — Eruption develops slowly and is of a pale, 



114 SKIN DISEASES. 

livid color. Hemorrhages without relief. Burning heat 
with alternate cold extremities. Very frequent weak in- 
termittent pulse. 

Verat. vir. — In the early stage with fever and pul- 
monary congestion. Cough, dyspnoea and pains in the 
chest. Convulsions preceding the outbreak of the erup- 
tion. 

Scarlatina. 

On the second day of illness the rash appears on the 
neck and face, and is made up of small red dots, which 
crowd together, forming patches of various sizes and ex- 
tent; after a while the whole surface becomes of an uni- 
form hue; on the third day, the eruption is seen on the 
body generally, the upper extremities, and the mucous 
surfaces visible to the eye; on the fourth day, the lower 
limbs are scarlet, whilst the surface is hot, dry, and harsh. 
The eruption, which may be called a general efflorescence 
of boiled lobster color, is most marked about the third or 
the fourth day, and it is generally more intense in color 
towards evening, especially in the loins and flexures of 
joints. On the trunk it is often " patchy." The erup- 
tion fades on the fifth day — first on the face; desquama- 
tion follows about the eighth or ninth day. 

The diagnosis between scarlatina and rubeola is the 
only one that requires notice. 

In scarlatina the rash appears on the second, in mea- 
sles on the fourth day after the first onset of symptoms. 
In scarlatina the rash is bright red (boiled lobster color); 
it is not crescentic, and it is uniform or not patchy, or as- 
sociated with intervals of normal integument. In measles 
the rash is of dull red color, and it takes the form of lit- 
tle crescentic patches, with intermediate lines of healthy 
skin. The skin in scarlatina is very dry, harsh, and 



ERYSIPELAS. 115 

pungent. In measles this is not so marked, nor is the 
subsequent desquamation so distinct or characteristic. 

In measles the changes in the mucous membranes are 
accompanied by secretion; there are coryza, suffusion of 
conjunctivae — in scarlatina, the mucous surfaces are red, 
dry, ulcerated; there is also sore throat of marked kind, 
but this is absent in rubeola. The aspect of the tongue 
is characteristic in scarlatina, and the pulse is very rapid 
and irritable. 

Erysipelas. 

For generations past, the old school has been enunciat- 
ing learned theories regarding the etiology of this disease. 
The '' status biliosus^' and the '^status saburralis^^ each 
had its day. Clogging of the pores of the skin, and con- 
sequent accumulation of acridities, which nature should 
have eliminated; and the theory that some noxious prin- 
ciple from without found entrance in some mysterious 
manner, each claimed due regard. Simple inflammation 
on the one hand, and specific inflammation, involving the 
lymphatics, on the other, have also had their advocates. 
Thus, most opposite theories have been advanced, have 
been held for a season, and then have fallen again into 
disrepute. It appears quite probable that some micro- 
germ may be the abnormal excitant, it serving as the 
agent through which the perverting force is enabled to 
act upon the vital dynamis. However, the observations 
of different investigators are not in harmony. 

Erysipelas is an acute febrile disease, characterized by 
a peculiar inflammation of the skin and enlargement of 
the neighboring lymph-glands, which is accompanied by 
more or less severe general symptoms. It is contagious 
and inoculable, and arises spontaneousl}^ under conditions 
not accurately determined; in the latter case it is called 



116 SKIN DISEASES. 

Idiopathic. When spreading by itvS own contagion, which 
diffuses itself through the air or is carried by linen or in- 
struments previously used for dressing patients with 
erysipelas, or by flies — it is called Traumatic^ and is 
mostly found in the surgical wards of hospitals. As the 
slightest scratch may be the recipient of the poison, the 
disease is often communicated to nurses and physicians. 
DaCosta found that the idiopathic form was almost inva- 
riably attended by albuminuria, which in the traumatic 
form was either absent or present only in a decidedly less 
marked degree. 

Erysipelas affects the skin in its whole thickness and 
the subcutaneous cellular tissue. All the layers of the 
corium and of the subcutaneous cellular tissue are edema- 
tous, swollen, and penetrated by large, finely granulated, 
white blood-corpuscles. The most important distinctive 
feature of erysipelas is its disposition to spread only by 
creeping uninterruptedly onwards without making jumps; 
it spreads like water in blotting paper. When on the 
scalp or face it is limited mostly to a more or less exten- 
sive portion of the skin of the head and face, and seldom 
descends over the neck to the trunk; on other parts of 
the body it is apt to spread over larger surfaces. 

The local symptoms are frequently preceded a day or 
two by a feeling of general malaise, chilliness and fever- 
ishness. Then the part affected begins to feel hot and 
tense; the skin reddens and swells, and becomes very 
sensitive to the touch. At the same time the adjacent 
lymphatic glands commence to swell. This inflamed 
portion assumes a red, smooth and shiny appearance, 
which is, however, darker and duller on the scalp than 
on other parts, and to the touch it gives the impression of 
a hard, stiff, caked mass. The inflammation gradually 



ERYSIPELAS. 117 

creeps on until it reaches from side to side of the scalp, 
down into the face, and even to the neck and shoulders. 

On the second or third da3^ generally, the redness and 
swelling reach their height, and, at this stage, in some 
cases, the epidermis becomes raised and filled with a yel- 
lowish, limpid fluid, sometimes tinged with blood, in the 
shape of large blisters — Erysipelas bullositm — which either 
dry up, or burst and become covered with crusts. 

During the height of the disea.se, the patient has high 
fever, with evening aggravations; his sleep is restless and 
full of dreams; he sometimes becomes delirious. On the 
fourth day the redness and swelling gradually subside on 
the places first attacked; while those parts which were in- 
vaded later stand yet in full bloom. By and by, however, 
they grow paler, softer, and assume a wrinkled appear- 
ance, as the swelling leaves; the crusts dry off, and on the 
whole surface the epidermis peels off in large flakes; the 
entire process lasting from about eight days to two weeks. 

But this is not invariably its course. Just in its very 
nature to creep on lies its danger. It may, by continuity 
of tissue^ wander to the mucous membrane of the nasal 
and phar3mgeal cavities, cause an oedema of the glottis, and 
affect the larynx, the bronchial tubes, and even produce 
pneumonia and pleuro-pericarditis. 

The tongue usually is covered with a white creamy 
coat, which dries gradually, becomes dirty yellow and, 
when the fever is protracted, blackish and crust-like; 
there is nausea and vomiting; sometimes diarrhoea and, 
what seems very remarkable, in rare cases profuse intes- 
tinal hemorrhage, in consequence of ulcers in the duo- 
denum, which generally have proved fatal, and remind 
one of similar symptoms which are occasionally observed 
after severe burns of the skin. In almost all idiopathic 
cases there is albuminuria. The fever, accompanying 



118 SKIN DISEASES. 

erysipelas, is characterized by a sudden rise of the 
temperature to even 104° F., or higher often within from 
eight to twelve hours, still rising, in some cases, to 107.6° 
F. When recovery approaches, it usually sinks as rapidly 
as it rose, and may attain its normal standard within a few 
hours, or in a single night; then desquamation of the 
epidermis, in the form of large or branny scales, and 
wrinkling of the skin terminate the local process. The 
hair usually falls out, but quickly grows again. The 
skin, too, recovers its normal vState; only upon the eye- 
lids, the scrotum, the prepuce and vulva, where it is 
naturally tender, it may in severe cases undergo a more 
or less extensive gangrenous destruction, and its duration 
be prolonged to several weeks, even months. 

Unlike to other infectious fevers, erysipelas leaves a 
very great susceptibility for renewed attacks. Not a few 
persons are subject to a periodically returning form — the 
so-called Habitual erysipelas, which mostly affects the 
face or lower extremities. 

Phlegmonous erysipelas is usually the result of an 
injury, and deep abscesses form in various parts of the 
body, discharging a foul, dirty pus. These cases are 
very serious, and often prove fatal. 

Dr. H. I^anderer relates the history of a case of melan- 
cholia of seven months' standing and progressing towards 
incurable dementia, in which the patient, a young girl, 
recovered completely from her mental affection simul- 
taneously with the subsidence of an attack of facial 
erysipelas spreading to the scalp. Two or three years 
had elapsed when the report was made, and she still 
maintains perfect health. 

Burns has collected twenty-two cases of tumors which 
were the seat of idiopathic erysipelas. Three cases of 
sarcoma were permanently cured. In four cases of 



TREATMENT. 119 

lymphona of the neck, some of the glands entirely disap- 
peared, and the others became smaller. In fiv^e cases 
erysipelas was artificially produced. Three of these cases 
were of carcinoma of the breast. In one of them the 
disease was not checked; in another the tumor was 
diminished to one-half its former size, and the third was 
practically cured, a small induration in the scar, the size 
of a pea, remaining. A multiple fibroid sarcoma was 
diminished in size, and an orbital sarcoma was unchanged. 
M}^ own observation has been limited to one case, a 
carcinoma of the breast. Erysipelas was artificially^ pro- 
duced, with the result of death in about three weeks. 
No effect was produced upon the carcinoma. 

Treatment. 

Local. — The use of oven- dried rj^e meal, or powdered 
starch may afford much comfort to the sufferer. The 
starch, for such purpose should be carefully prepared by 
washing it in cold water in order to remove all foreign 
matters; it should then be allowed to settle, the supernat- 
ant water poured off, and the starch then slowly dried. 
During the dr3'ing process it should, from time to time, 
be broken up so as to expose fresh surfaces, thereby 
hastening the process. The starch is thus readily con- 
verted into an almost impalpable powder, which, when 
applied to the inflamed surface, promptly relieves the 
itching and burning. Applications containing fattj^ sub- 
stances are usually harmful in their effects. 

The following makes an excellent application in some 
cases: The site of the disease is to be painted with this 
mixture every two hours, and then covered with anti- 
septic gauze. 



120 SKIN DISEASES. 

1^ Carbolic acid, 

Tincture of iodine, 
Rectified spirit, aa 5j- 
Oil of turpentine, ,^jj. 
Glycerin, 5jjj. 

Dr. Hilsman recommends the application of strong heat 
to the parts affected. This procedure is evidently homoeo- 
pathic. Erysipelas is a dermatitis of a specific character, 
and the application of a high degree of heat produces, 
itself, a dermatitis. Whether the high heat kills the 
microbe of erysipelas or not does not affect the homoeo- 
pathicity of the treatment. The parts attacked by ery- 
sipelas are covered with heavy felt and then a red-hot 
smoothing iron applied forward and backward over the 
felt which heats the affected parts and removes the ery- 
sipelas. Some cases are intolerant of heat. 

The external application of raw cotton to the inflamed 
parts, to keep off the air, as in burns, is recommended by 
several physicians. 

I have found the application of Ver. vir, one teaspoon- 
ful of tincture to half a glass of warm water, to be very 
soothing. 

In domestic practice a poultice of raw cranberries, or 
scraped potatoes, or raw carrots, is often used with 
decided benefit. 

The indications for remedies are as follows: 

Acojiite. — Intense synochal fever, with restlessness, fear 
of death, etc. 

Ammon. carb. — Erysipelas of old people, when cerebral 
symptoms are developed, while the eruption is still out; 
debility and soreness of the whole body; tendency to 
gangrenous destruction. 

Anthracin. — Erysipelas gangrenosa with typhoid symp- 
toms; great pain in head and dizziness; delirium and un- 



TREATMENT. 121 

consciousness; great prostration and depression; fainting 
and copious sweating; sleep short, unrefreshing, more 
like stupor. 

Apis. — Erysipelas, with bruised sore pain and much 
swelling; stinging, burning, prickling pains in the skin, 
which is very sensitive to the slightest touch; erysipelas 
of the face a?id scalp, with puffiness of the eyelids; typhoid 
tendency; sphacelated spots here and there; the whole 
eruption rather pale than deep red; chronic erysipelas, 
recurring periodically^; apt to go from right to left. 

Arctium lappa. — Chronic erysipelas is said to be re- 
moved permanently b}^ its persistent use. {Gymnocladus 
Ptelea.) 

Arnica. — Phlegmonous erysipelas, with extreme tender- 
ness and painfulness on pressure, with tendency to the 
formation of bullae; the swelling hot, hard, shining, even 
deep red; the patient feels nervous, cannot stand pain, 
and feels tired as after hard work, or as if beaten. 

Arsejiic. — Irregular progress; disposition to internal 
organs; terrible restlessness and sinking of strength; 
fainting pain in the bowels and hemorrhage, as sometimes 
occurs in large burns. 

Belladonna. — Intense erysipelatous fever, accompanied 
by inflamed swellings, passing even into gangrene; skin 
imparts a burning sensation to the examining hand; 
phlegmonous erysipelas; tendency to attack the brain, 
with delirium; severe headache, furious look, violent 
thirst, dry tongue, parched lips, etc.; smooth and shining 
erysipelas on the right side of the face; tendency of in- 
flammation to spread in streaks. 

Borax. — Erysipelas of the left side of the face, painful 
when laughing, with sensation as if covered by cobwebs. 

Bryonia.— Erysipelas articulorum^ with drawing-tearing 
pains, increased by motion. 
9 



122 SKIN DISEASES. 

Camphora. — Great exhaustion ; coldness of skin; breath- 
ing scarcely audible or visible. 

Cantharides. — Typhoid erysipelas; vesicular erysipelas ^ 
with fine stinging-burning pains internally and externally, 
the patient being uneasy, restless, distressed, dissatisfied; 
unquenchable thirst, with disgust for all sorts of drinks; 
kidneys and bladder involved; erysipelas begins on 
dorsum of nose and spreads to both cheeks, but more to 
the right. 

Comocladia. — Burning on face and eyes, worse to- 
wards evening; excessive swelling of the face, with 
tormenting itching and swelling; corrosive itching of the 
head; dizziness and heaviness of the head, with shooting 
pains, relieved by motion. 

Croton tigl. — CKdematous swelling of eyelids; large 
and small blisters; intermediate skin cracked and peeling 
off; violent burning. 

Cuprum. — Sudden sinking of the swelling and chang- 
ing into a bluish color; violent brain symptoms. 

Euphorbium. — Erysipelas of head and face, with dig- 
ging, boring, and gnawing pains, followed, when amelior- 
ated, by creeping and itching of the part. Considerable 
swelling of the parts affected, with small vesicles dis- 
charging a rather yellowish fluid. 

Eucalyptus glob. — General erysipelas, with putrid 
dysenteric passages; typhoid symptoms. A desire to be 
constantly moving about. 

Ferrum phos. — Rose and erysipelatous inflammations 
of the skin, for the fever and pain and severe symptoms 
of inflammation. 

Graphites. — Chronic disposition of the disease to return, 
from right to left; phlegmonous erysipelas of head and 
face, with burning-tingling pains; swelling and induration 



TREATMENT. 123 

of lymphatics and glands; very liable to take cold from 
the least cold air. 

Hydrastis. — Wandering from left side of nose to right 
over whole face and scalp; intense pain in the lumbar 
region; chills down the back; extremely restless; dis- 
turbed by noise; delirium; urine suppressed. 

Hydrophyllimi Virg. — Burning and watering of e3^es, 
with slight itching. Eyelids swollen, sclerotica injected, 
fiery redness, sensitive to light. In the morning eyelids 
agglutinated. 

Ipecac. — Retrocession of eruption, with vomiting. 

Kalicarb. — From right to left side; oedematous swell- 
ing under the eyebrows. When touched ever so slightly 
on his feet, he jerks them up much frightened; he talks 
of pigeons flj-ing in the room, which he tries to catch with 
his hands; he gets regularly worse about 3 o'clock A. m. 
After previous attacks. 

Kali mur. — Schiissler says this is the chief remedy in 
vesicular erysipelas. 

Kali sulph. — Blistering variety, to facilitate the falling 
off of scabs. 

Lachesis. — Where the cerebral affection does not yield 
to Belladoiuia ; bloated red face, attended with heat; 
headache and coldness of the extremities; one-sided tense 
headache, extending from occiput to eyes, with vomiting, 
vertigo, tendency to faint, and numbness; left side espe- 
cially affected. {Bell., right). 

Ledum. — Erysipelas of face and eyes from bites of 
insects. 

Nati'um phos. — Er3^sipelas, smooth, red, shiny, ting- 
ling or painful swelling of the skin. 

Natrum sulph. — For the smooth form, with or without 
vomiting of bile. 

Natrum benzoicum — Dr. Haberkorn uses this drug in 



124 SKIN DISEASES. 

full physiological doses and given in seltzer water. He 
has treated fifty cases without a death, and reports that 
almost uniformly within forty-eight hours the tempera- 
ture was reduced to normal, and the patient felt well. 
The local symptoms quickly subsided, ending with des- 
quamation. No local treatment was used. 

Nux vomica. — Gastrosis the cause of the erysipelas; 
burning itching all over the skin, worse in the evening; 
great debility, with oversensitiveness of all the senses, and 
irritability of temper. 

Pulsatilla. — Erysipelas erraticum ; bluish, spreading 
rapidly, especially about buttocks and thighs; smooth 
skin, headache; mucous diarrhoea, nausea, neither appetite 
nor thirst. 

Rh2is rad. — Phlegmonous erysipelas, especially when it 
begins in the ankle and moves gradually up the leg in 
the deeper tissues; sometimes with very little fever. 

Rhtis tox. — Vesicular erysipelas ; itching all over, espe- 
cially on hairy parts; after scratching burning; swelling 
and redness of the face, with partial or entire closure of 
the eyelids; bruised feeling in the limbs and back; 
tendency to attack the brain; dark bluish redness of the 
parts affected. 

Rhus ven. — The symptoms usually begin by itching 
and tumefaction in the hands and face, the swelling 
gradually spreading over different parts of the body. 

Ruta. — In combination with wounds. 

Sulphur. — Erysipelas migrans, appearing in subsequent 
throes, and running its course for a longer time than 
usual. Helps often when all other remedies fail. 

Terebinthina. — Erysipelas buUosum, skin red and in- 
durated, swollen; clusters of small, flat, pale, yellow vesi- 
cles, often confluent, with large red halos, here and there 
turning bluish-black, showing a tendency to gangrene. 



RUBELLA. 125 

Trichlorphe7iol. — The daily application of a 5 to 10 per 
cent, solution of Trichloi^phenol by means of a brush to 
an erysipelatous surface has been accompanied by ex- 
cellent results. 

Verat. vir. — Right side of head and face much swollen 
and covered with large blisters; headache; high fever; 
no sleep; no appetite; intermitting attacks of nausea; 
occasional vomiting of the water drank. It was applied 
low, externally and internally. 

Rubella. 

There is a form of eruption which resembles measles, 
but differs in several particulars, and about which some 
dispute exists. It has received several names, as, for ex- 
ample, rubeola notha, roseola, rotheln, rosalia, German 
measles, etc. Rubella is undoubtedly the proper term for 
this rose-red colored eruptive fever. Very little is written 
of it in our text- books, although it is a disease of frequent 
occurrence. It is probably contagious, and is more prone 
to be epidemic than either measles or scarlet fever. One 
attack usually protects from subsequent invasion, but 
does not protect from either measles or scarlet fever. 

Rubella occurs chiefl}^ between the ages of three and 
twelve years. It may be seen in infants, rarely adults, 
and is characterized by stages of incubation, invasion, 
eruption, and decline, and closely resembles measles in 
some cases, and scarlet fever in others. 

The history of the patient will aid diagnosis. Has the 
child had either scarlet fever or measles ? Are either of 
these diseases existing epidemically? The stage of 
incubation varies from four to twenty-one days. The in- 
vasion stage is from twelve to twenty-four hours. Catar- 
rhal symptoms absent,. though the fauces are reddened. 
One of the most characteristic symptoms of rubella is the 



126 SKIN DISEASES. 

enlargement and induration of the cervical, post-cervical 
and post-auricular glands. Occasionally only a fev^ of 
these glands may be affected, but more often the entire 
chain, also the lymphatic glands in other parts of the 
body, may be involved. 

The eruption may first appear, like the eruption of 
measles, upon the face, but spreads more rapidly over the 
surface, or it may appear over the whole surface at once; 
it is most intense during the first day; it may rapidly 
fade in one part and appear in another; in color it is of a 
pale rose-red, but not so red as scarlet fever, nor so 
bluish as measles. 

Over the more vascular parts it is often slightly 
elevated, with a tendency to become confluent. In other 
parts it is more maculate in form and of a much higher 
color in the centre; nor do we have the characteristic 
odor so peculiar to measles. The tongue is usually 
slightly coated and cleans in patches, producing the so- 
called "mapped tongue" but never the strawberry 
tongue. Desquamation is slightly branny, and follows 
the eruption in nearly every case. In some cases it is 
well marked; in others, however, it may only be observed 
on some particular parts, as about the nose, and may last 
for three weeks or more. The patient very quickly re- 
covers; there is no dropsy or renal disease following in 
its wake. 

For internal remedies consult Rubeola. 

Frambcesia, or Yaws. 

This disease is confined almost exclusively to the negro 
race; it originated on Guinea coast of Africa. It is a 
constitutional disorder, attended often with fever, and by 
a peculiar papular eruption, sometimes having almost a 
crimson appearance like that of a wild raspberry, hence 



FRAMBCESIA OR YAWS. 127 

its name. Its probable cause was syphilis, spread among 
the negroes of West Africa by the English traders. Proofs 
of its venereal origin are as follows: 

1. That it is contagious, and can be inoculated in the 
same manner as matter taken from an indurated chancre. 

2. It is accompanied by ulcerated throat and pains in 
the bones. 

3. The eruption is of a secondary specific type, though 
not of the usual lean-ham color but yellowish- white, hav- 
ing an ulcerative tendency. 

4. It is transmitted by parents to their offspring. 

5. Such children infect those who suckle them. 

6. The disease is much improved by mercurial treat- 
ment. 

7. The pathological histology of the papules resembles 
the tissues found in syphilitic gummata. 

The disease begins with malaise and fever, pains in the 
head and bones which are worse at night, and ulcerated 
throat. The body becomes covered with yellowish- white 
patches of varying size, with the formation of papules 
which break down and ulcerate under a scab with great 
loss of tissue. The eruption generally breaks out in the 
face, the neck, the upper and lower extremities, the parts 
of generation, the perineum, the hips, and about the 
anus. They are much less frequently observed about the 
trunk, and are not so often seen on the hairy scalp. They 
may form on the nostrils where the mucous membrane 
joins the skin, and here the yaws may assume an 
elongated form, nearly closing the nostril, and hanging 
down on the lip. The same form may be observed about 
the eyelid. Near to the mouth they may appear in such 
numbers and so closely set together as to form almost a 
ring round the mouth. This is especially the case in 
children. Around the anus also they sometimes coalesce 



128 SKIN DISEASES. 

and form one projecting circular band an inch and more 
in breadth. 

An attack of framboesia varies much in severity as re- 
gards the size and number of actual yaws. 

After the disappearance of the yaws without ulceration, 
a dark spot is left where each yaw has been and of cor- 
responding size. These spots are of deeper shade than 
the natural black of the skin, and they remain for many 
years, but may possibly wear out in time. The skin is 
quite smooth, and the texture uninjured. In white 
skins the spots are of lighter hue than natural. When, 
however, the disease ulcerates scars are left. 

Should yaws not properly develop its several early stages 
the general health suffers, the patient becomes cachectic, 
unhealthy ulcerations appear over the body, especially 
about the joints, which swell and become painful, and 
offensive effluvia are given off from the body, and the at- 
tacked dies a lingering death, or becomes crippled, more 
or less, by the deep ulcerations. 

The mercurial preparations, and Jatropha curcas, are 
the principal internal remedies 



CHAPTER VII. 



PAPULAR INFLAMMATIONS. 

Lichen Planus. 

Lichen planus is a non-contagious affection of the skin, 
characterized by the development of small, flattened 
papules, which frequently present a distinct central de- 
pression or umbilicus. 

Lichen planus is an eruption of pimples, remarkable 
for their color, their figure, their structure, their habits 
of isolated and aggregated development, their habitat, 
their local and chronic character, and for the melasmic 
stains which they leave behind them when they disap- 
pear. 

The color of the pimples is a dull crimson-red, more or 
less livid, and suffused with a purplish or lilac tinge. 

In figure the papulae are flattened, smooth, and de- 
pressed on the summit, angular in outline, but slightty 
elevated, and of a size ranging between one and three 
lines in diameter ; the flatness is rendered more con- 
spicuous by the summit of the papule being occupied by 
a thin, horny, semi-transparent lamina of cuticle, de- 
pressed on the surface, and marked by the aperture of a 
follicle, which represents a sort of hilum. In structure, 
the papule of lichen planus is a hypersemia with exuda- 
tion, surrounding a follicle and surrounding a thin layer of 
horny, transparent cuticle ; while the aperture of the 



130 SKIN DISEASES. 

follicle and its conical epidermic plug are visible in the 
center of the horny plate. The horny covering is in no- 
wise a scale ; it rises and falls with the papule and neither 
separates nor exfoliates. 

Lichen planus presents two principal forms of manifes- 
tation — discrete and aggregate. 

The habitat of the eruption is also characteristic of the 
identity of lichen planus. It is pretty constantly met 
with on the front of the forearm, just above the wrist ; 
in the hollow of the loins; on the lower half of the abdo- 
men; on the hips; around the knees, particularly over the 
mass of the vastus internus muscle; on the forearms and 
calves of the legs, and in women around the waist and in the 
grooves occasioned by the garters. We have seen it also, 
but less frequently, on the palms of the hands and soles 
of the feet; and in two instances on the tongue, the 
buccal membrane, and the mucous lining of the fauces. 

lyichen planus is essentially chronic and local in its 
habits. In distribution it is generally symmetrical, but 
occasionally is limited to one side of the body; sometimes 
occurring on one side in the upper extremity, and on the 
other in the lower. It has no constitutional symptoms of 
its own, and frequently prevails with very little disturb- 
ance of any kind. 

Of course, the totality of the characters above noted 
are not to be found in every case. The characteristic 
features, however, are the flattened umbilical papules. 
This central depression may not be noted in every papule; 
and when a number of them have run together and 
coalesced, it is commonly absent, and met with only on 
those in the neighborhood of, but which do not form a 
part of, the patch. 

The duration of the affection is indefinite. It may 
undergo resolution, and the papules disappear after three 



LICHEN PLANUS. 131 

or four months; or, especiall}^ when the eruption is ex- 
tensive, may resist the best-directed treatment for a year 
or more. 

Etiology. — No one has thus far offered a plausible ex- 
planation of the causes of lichen planus. It is undoubt- 
edly a constitutional affection, but whether due to cer- 
tain unknown changes in the blood, or to a reflected irri- 
tation from some special internal organ, is entireh^ un- 
known. 

Diagnosis. — In general aspect the affection may be 
mistaken for a papular syphilide, or a papular eczema, 
but hardly for any other than those two diseases, except 
it be the lichen ruber of Hebra. The positive features, 
however, that have been detailed above do not occur in 
the diseases mentioned, and are sufficient of themselves 
to establish the diagnosis. 

The prognosis of lichen planus is favorable, as there 
is little or no evidence that it tends either directly or 
indirectly to shorten life. The duration of a given erup- 
tion, however, is very uncertain, except that, in a general 
way, the more extensive the lesions the longer they may 
be expected to remain. 

Treatment. — Locally, chrysarobin, thirty grains, 
with one ounce of traumaticin (liquor gutta percha). This 
should be painted on the spots daily until a considerable 
degree of local irritation is produced. Sedative applica- 
tions should then be applied for a few days, and the skin 
allowed to recover from the effects of the drug. A single 
course of this sort will cause most of the spots to disap- 
pear. 

When there is much itching, temporary relief is af- 
forded by the application of cloths wrung out in hot 
water. Should the itching prove obstinate, a weak car- 



132 SKIN DISEASES. 

bolized oil and lime water lotion, or grindelia robusta, 
dr. j. to water gj may be used. 

The following ointment has proven very beneficial in 
many cases, to relieve the itching of lichen planus and 
eczema: 

9^ Chloral hydratis, dr. ss. 
Camph. pulv., dr. ss. 
Acidi carbolici, m. x. 
Balsum peru., dr. j. 
Menthol, grs. xx. 
Ung, zinci oxidi, q. s. ad. ^j- 
M. fl. unguent., Sig. Apply morning and night. 

As regards internal treatment the old school rely al- 
most entirely upon arsenic, giving preference to Fowler's 
solution. 

The patient should be liberally fed and well hygiened. 

Homoeopathic Remedies. 

A?iHmon crud. is the principal internal remedy. 
. Others are indicated as follows: 

Agaricus 7nusc. — Eruption of small pimples with red 
areolae and violent itching. Sensation in various parts 
as if ice cold needles were piercing the skin. In light 
complexioned persons and drunkards. 

Arsen. alb. — In chronic cases. Burning itching, pain- 
ful after scratching. Great weakness and- prostration. 
Oppression of breathing. 

Chinin. ars. — In the diffused form with threatening 
marasmus. Chronic intestinal derangements. 

Iodine. — Small dry, red pimples on the arms, chest 
and back, with jerking sensation while appearing. 
Rough, dry skin. Emaciation. Ravenous hunger. 

Kali bichrom. — Papular eruptions on the forearms. 
Rheumatic pains in the limbs. In fat light complexioned 
individuals. 



LICHEN RUBER. 133 

Ledum. — Eruption of pimples on the forehead as in 
brandy drinkers. Eruption of small pimples like red 
millet seeds over the body. Excessive itching on the 
backs of both feet, worse after scratching, and by warmth 
of bed. Relieved after scratching the feet sore. 

Nux jugla7is. — Red pimples on face, neck, shoulders 
and back. Little tubercles with hard scurf on the in- 
step. 

Potassium iodide. — Lichen on the face and shoulders. 
Sensitive swelling of the thyroid gland, great general 
debility. 

Sarsaparilla. — Red dry pimples. Burning itching 
with chilliness. 

Staphisagria. — Itching pimplj' eruption over the face 
and behind the ears, with rough skin. Burning of the 
eruption after scratching. 

Sulphur iodide. — Red pimples on the nose, chin and 
arms, with itching. In chronic cases. 

Lichen Ruber. 

To Hebra is due the description of an eruption to which 
he applied the name above given. It, like lichen planus, 
is a papular affection, but the papules present a different 
aspect, and they are acuminate, not Jlatte?ied. They do 
not exhibit the central hilum. The papules rarely 
if ever undergo spontaneous resolution, but persist 
throughout the entire period of the disease, which, as a 
rule, terminates with the patient's death. The papules 
at first are discrete, and each is decked with a minute 
adhering scale. New papules continue to form, and in 
time considerable patches, raised, red, and scaly, come 
into existence. 

The prognosis is essentially grave. A few cases have 



134 SKIN DISEASES. 

been reported cured, but in the majority the disease lasted 
until death terminated the patient's existence. 

Externally we may seek with some measure of success 
to procure resolution of the lesions by active substitutive 
treatment, involving the use of iodine, bichloride of 
mercury, carbolic acid, strong alkaline applications, etc.; 
but whether either or all of them is capable of retarding 
the usual termination is problematical. 

There are several varieties of lichen given by different 
authors, but, as they are but forms of either the two above 
mentioned or lichen simplex, we will omit them, especially 
as they will be referred to in the description of the various 
lesions of the skin, and simply give a description of lichen 
simplex. 

One case, reported in one of our journals I would like 
to mention, as showing the efficacy of a well chosen ho- 
moeopathic remedy. 

The case, as reported, is as follows: 

Cure of Lichen Urticarius by Thuja. 

A gentleman brought his fourteen year old son for 
treatment for a skin affection that had defied two able 
specialists. He had been treated both internally and ex- 
ternally and strictly dieted — but without effect. The 
lichen was wont to come periodically in the warm weather; 
the patient literally tears himself because of the irritation. 
The rash was much worse on the left side, that being the 
side on which he was vaccinated. Thuja 30, was ordered 
in very infrequent doses. The spots continued to appear 
for a week after taking the powders, then they disap- 
peared and he has remained quite free from them, 
although eating freely of meat, fish and fruit. It may be 
remarked that the cure took effect during warm weather, 
and that the uticarius lumps were described as worse in 
the warmth. 



LICHEN SIMPLEX. 135 



Lichen Simplex. 

Ivichen simplex includes as its sub- varieties, ly. circurn- 
scriptus, L. agrius, and L. pilaris. 

Lichen shnplex is often seen in the summer, sometimes 
recurring in the same person several times; the papules 
are flesh- colored, red, smallish, sometimes very minute, 
and more or less pointed, lasting a week or so, and fol- 
lowed up by the development of others; the papules are 
usually seen on the back of the hand, the outer aspect of 
the forearm, the neck, and the thighs. The}^ are accom- 
panied by a good deal of itching. The papules disappear 
by resorption, and never become vesicles or pustules. 
This lichen may last for weeks and months. The disap- 
pearance of the papules gives rise to a little desquamation. 
The skin generally is dry and thickened. The disease is 
rare. L. circumscriptus is the name given to the disease 
when the papules are collected together into little round 
or roundish elevated patches; the border of the diseased 
patches in such cases is well defined and papular, the 
surface elevated, rough and dry to the feel; its area in- 
creases by circumferential enlargement, and its centre 
presently clears somewhat; there are generally several 
circles, and their most usual situation is the back of the 
forearm or the hip; at other times the back of the hand 
or calf may be affected, or the inside of the thigh. The 
patches after a while get more or less scaly, or inflamed 
and cracked, simulating eczema, but never actually dis- 
charging; or in consequence of the centre healing, assume 
a circinate form; but the history, absence of moisture, 
and the dry red roughened base are distinctive. 

Lichen agrius^ or the inflamed form of lichen, diflfers 



136 SKIN DISEASl^S. 

from the above in the presence of secretion, and hence 
approaches eczema; but it is, as its name implies, an 
acute, inflamed Hchen. The local manisfestation consists 
of clustered or closely packed red papulae, accompanied 
by intense itching and burning, causing the patient to 
scratch violently; this in its turn sets up additional irrita- 
tion, the torn and excoriated papulae are inflamed, and 
exude a thin fluid; the whole patch thickens, fissures, 
and becomes covered over with thin scales, not the yellow 
puriform scales of eczema. I^ichen agrius may also arise 
by inflammation of the chronic stage of any of the other 
forms of lichen, and not primarily as an acute form. 
The acute state lasts about ten or fifteen days, the chronic 
weeks or months; this variety of lichen is observed about 
the back, neck, legs, arms, and shoulders; it constitutes 
one aspect of grocers', bricklayers', and bakers' itch. 
Vesicles and pustules may, however, form; and then 
there is an inflamed, raised, reddened, excoriated, dis- 
charging, fissured patch, the seat of intense and often in- 
tolerable itching and burning, made worse by stimulation 
of all kinds, especially the warmth of bed. The disease 
either subsides or increases by the development of fresh 
crops of papulae. 

Lichen pilaris. — Occasionally one sees, either alone or 
in conjunction with ordinary lichen, or other disease 
where the skin is hyperaemic, little elevations like 
papulae, which are, however, seated at the hair follicles; 
the hair in fact piercing the centre of the papule. A dis- 
tinct lump is felt by the finger. Hyperaemia of the fol- 
licular plexus is followed by fibrous deposit outside the 
follicle, forming a papule. 

When this is accompanied by inflammatory deposit, 
then solid papules are formed at the hair follicles and 
constitute lichen pilaris. 



LICHEN SIMPLEX. 137 

Lichen pilaris is then ' ' fibrous inflammation ' ' seated at 
the upper part of the hair follicles, the effusion of plastic 
lymph taking place around the follicular walls, and pro- 
ducing, according to its degree, more or less well marked 
and distinct papulation, each elevation being perforated 
by a hair. It must not be confounded with pityriasis 
pilaris, which is merely a desquamation of cuticular 
cells into, and distending, the hair follicles, preventing 
the formation of the hair, and producing a blocking up 
of the follicles, the collected cells forming " a knot " in 
the upper part of each follicle, a state of things that may 
occur after pityriasis rubra, or as the result of an in- 
active state of skin, especially about the thighs, and 
which latter only needs the free use of soap and water 
for its removal. 

Prognosis. — As a rule, the simple forms get well, 
with proper treatment, in two or three weeks. L. cir- 
cumscriphis and agrius are often very obstinate. 

Lichen appears to be common in those of nervous tem- 
perament and in summer time. It attacks all ages, and 
is evoked by local and reflex irritation, by a deficiency of 
alkali in the system; irregularities — mental, phj^sical, 
alimentative, etc.; hereditary tendency; certain occupa- 
tions — e. g. , cooks, bakers, grocers, bricklayers, etc. ; hot 
climates, all seem to be causative factors of this disease. 

Diagnosis. — We frequently find some difficulty here. 
The chief points to remember in regard to lichen are the 
dry and thickened state of the skin and the presence of 
papules, which are always to be found, if the disease is 
in patches, at the extending edge; the hard feel of the 
papules, and their tingling or itchiness. Lichen simplex 
and scabies may be confounded, Liche7i is uniform, 
scabies multiform. In scabies, besides papules there are 
vesicles, often pustules, and the papules are not so closely 

ID 



138 SKIN DISEASES. 

aggregated; the eruption also is in the line of flexion, 
not, as in lichen, in that of extension — /. e., lichen is 
seen chiefly on the outer aspect of the arm; it may occur 
on the back of the hands and fingers, but it is not inter- 
digital, lyichen simplex never occurs in the feet; it is 
common on the face; scabies is not. In scabies, too, 
there is the characteristic vesicle and sillon, whilst the 
disease is contagious and easily removed by sulphur 
treatment. 

Phtheiriasis may simulate lichen, but it is associated 
with an unhealthy, relaxed, muddy, dirty state of the 
skin — flabby is the word; the papules (which are pale) 
are fewer in number, and each is marked at its apex with 
a dark speck (dried blood) effused as the result of scratch- 
ing. The skin is not thickened and dry, as in lichen, 
nor is there any attempt at scaliness, as in lichen, 
nor aggregation of papules into patches or groups. 
Phtheiriasis is essentially a disease of advanced age. It 
occurs in the uncleanly, and there is often a peculiar 
urticated state of skin, seen very markedly on the back 
and chest, produced by an exaggeration of the spaces 
enclosed by the normal furrows. Phtheiriasis does not 
occur about the face; the sensation is one of formication, 
and is altogether out of proportion to the local disease, 
whilst pediculi may frequently be detected in the folds of 
the linen. 

Lichen agrius resembles eczema, but the latter is moist 
and discharging, occurs in delicate and thin, not in harsh 
dry skins; again, the history and edge of the patch in 
lichen point to the existence of papules; then the patch is 
much thicker and harsher than in eczema, and wants its 
thick yellow crusts; the latter in lichen are thin, pretty 
few, and " flimsy." 

It is impoi:tant to remember that scabies may be com- 



LICHEN SIMPLEX. 139 

plicated with lichen, and the latter may be set up as the 
result of irritation in scabies. One sees this state of things 
very frequently in the hot season — the irritation of a few 
scabious spots bringing out a pretty general lichen. 

Treatment. — The following ointments are sometimes 
useful : 

9? Chloroform, M. vjjj. 

Glycerine, 3j- 

White wax ointment, 5vj. 

Cyanide of potassium, gr. iv. 
M. Sig. Apply night and morning. 

Or, 

9^ Carbonate of lead, gr. iv. 

Glyerine, 5j. 

Simple cerate, gj. 
M. Sig. Use as above. 

For the itching, the prescription mentioned in lichen 
planus, or, 

1^ Dilute hydrocyanic acid, dr. ss. 

Brandish's solution of potash, dr. j. 

Rose water, gvj. 
M. Apply as needed. 

One of the following internal remedies will generally 
be indicated: 

Alumina. — Red pimples on the face. Pimples on the 
neck and back. Intolerable itching of the whole body, 
especially when becoming heated in bed. 

Ammon. mur. — Pimples on the back of the hands 
desquamating next day. 

Anatherimn. — Red pimples with itching and burning. 
Scarlet skin with burning. 

Anthnon. crud. — Small red pimples on right shoulder. 
From digestive derangement. 

Arsen. alb, — In chronic cases with burning itching. 



140 SKIN DISEASES. 

Belladonna. — Papular eruption on the hands like lichen 
agrius. 

Bovista. — Red pimples on the foot. 

Bryonia. — Pimples on the abdomen and hips. 

Castanea vesca. — -Several small pimples on the right 
thigh, back of the left ear, and on the left upper lip. 

Caladium. — Pimples on the nions veneris. Soreness of 
pimples to the touch. 

Kreasote. — Forehead covered with pimples the size of 
millet seeds. 

Ledum. — Small pimples like red millet seeds over the 
whole body. In brandy drinkers. 

Mercurius. — Pimples on the labia. Voluptuous itching. 
Itching changes to burning by scratching. 

Nabulus serp. — Pimples on the face about the nose, 
upper lip and chest with itching. 

Natrum carb. — Pimples on the face and lips. White 
pimples on the nose. 

Nux juglans. — Red pimples on the face and neck. 
Pricking itching. 

Plantago. — Hard white flattened isolated papules on the 
inside of the thigh. Some papules have a red point in the 
centre. 

Phytolacca. — Pimples with itching on the left leg. 
Worse first part of the night. 

Rumex crisp. — Red pimples on calves of the legs, with 
itching worse immediately after undressing. 

Sepia. — Pimples close together on the face. Pimples 
on the legs, and in the bends of the joints. 

Sulphur. — Pimples on inner parts of the thighs. In 
simple cases. 

Sidph. iod. — Red pimples on the nose, chin and arms. 

Tilia. — Eruption of small red, rather deeply seated 
pimples, with violent itching and burning like fire after 
scratching. 



LICHEN SCROFULOSORUM. 141 



Lichen Scrofulosorum. 



The disease occurs essentially in strumous subjects. It 
shows itself in the form of little elevations about the size 
of millet seeds, either pale, or yellowish, or a brownish- 
red color. These papules never become vesicles; they 
are grouped together, sometimes in circles, sometimes in 
segments of circles. The papules are seated at the hair 
follicles, and are by-and-by covered by thin scales; the 
patches itch slightly, but not so much as to be scratched, 
and hence they are not excoriated. 

The patches remain in one condition a long time, and 
undergo no changes but exfoliation and involution. The 
disease is limited to the trunk, the bellj^, the breast, and 
back, being rare on the extremities. Its course is very 
slow. Generally speaking many groups of papules 
develop at the same time. They soon reach the height 
of development, and then remain awhile in statu quo. In 
consequence of the absence of local symptoms, the disease 
exists unnoticed for some time. When at its acme, other 
symptoms are observed; between the groups, and at the 
same time, on parts free from lichen — that is, on the ex- 
tremities and face — more or less numerous isolated bluish- 
red elevations are developed; these are about the size of 
lentils, and look very much like common acne; some of 
the papules are said to contain pus; then by-and-by they 
wither and disappear, leaving dark pigmented lentil-sized 
marks in some places, whilst in others fresh formations 
take place. The skin between the diseased patches is the 
seat of desquamation, the scales being pale and shining, 
whilst the whole skin may assume a cachectic appearance. 
In 90 per cent., the disease is observed in markedly 



142 SKIN DISEAvSES. 

scrofulous subjects, and particularly children, together 
with swelling of the submaxillary, cervical, and axillary 
glands, with caries and necrosis, or tabes mesenterica. 

The treatment is the same as for scrofula. Cod-liver 
oil internally, with inunctions of oil externally is a great 
aid in treatment of these cases. 

Strophulus. 

The disease is popularly known as the red gum, tooth- 
rash, etc. ; some authors look upon it as the lichen of 
infants. This is wrong, as lichen is an affection of the 
papillary layer of the derma, about the hair follicles, while 
strophulus is at the sweat follicles, and is characterized 
by the appearance of small red or white papules, varying 
in size from pins' heads to small millet seeds; they are 
irregularly dispersed or slightly aggregated, and inter- 
mingled with more or less erythema; are attended with 
itching, sometimes slight moisture, and desquamation. 
It makes its appearance on the most exposed parts, the 
face especially, but also the neck, arms, and limbs, in 
successive crops. There are two forms of the affection. 
One variety, mostly due to over-clothing, appears in infants 
a few weeks old. The other variety is frequently met 
with during the period of dentition, lasts longer than the 
former variety, and is often associated with gastro-intes- 
tinal disturbance. 

Treatment. — Scrupulous cleanliness must be observed; 
the diet should be carefully regulated; the child must not 
be too much wrapped up; the use of soap must be 
avoided; tepid sponging, spirit or alkaline lotions, may 
be used locally. A very useful lotion is: 



PRURIGO. 143 

Ijfc Carbonate of soda, gr. xx. 

Glycerine, dr. jj. 

Rose-water, ^vj. 
M. x\pply locally. 

Almond emulsion and lime- Water may be also used. 

Lancing the gums is proper only when they are swollen 
or so tender as to distress the child. 

Chamomilla is the principal internal remedy. 

Other remedies may be indicated as follows: 

Amnion, carb. — Rash appears more on the right side. 
Frequent starting in sleep as if in affright. 

AnHnio7i. crud. — Child cannot bear to be touched or 
looked at. Disturbance of digestion, nausea, vomiting 
and diarrhoea. Tongue, thickly coated white. 

Calc. carb. — Eruption attended with swelling of glands, 
heat, thirst and want of appetite. Scrofulous children 
and during dentition. 

Chamom. — Eruption of red pimples, itching worse at 
night. Great sensitiveness of the nervous system with 
irritability, cannot stand pain, the wind, or currents of 
air. Child very cross and restless, wants to be carried. 

Lycopodium. — The skin dry and hot, with yellow color, 
especially of the face, and emaciation. Eruptive itching, 
worse from 4 to 8 p. m. Red sand in urine. 

Nitric acid. — Eruption with burning, itching pains, 
worse at night, from change of weather, or during per- 
spiration. Strong smelling urine, like that of horses. 

Prurigo. 

The older writers used this term in a variety of ways, 
and included under it several unrelated affections which 
possessed the common symptoms of itching. Modern 
usage, however, confines it to a definite affection, first 
clearly described by Hebra. 



144 SKIN DISEASES. 

The disease is chiefl}^ characterized by intense itching, 
often commencing early in life, and extending over a 
number of years. In the beginning little will be found 
in the way of lesion other than a few scattered papules, 
which are little if at all raised above the surface of the 
skin, and are perceived more readily by the sense of 
touch than by that of sight. They appear to be seated 
in the skin, and do not, except when directly irritated, 
project above it. Accompanying the papules we find the 
usual indications of all itching affections, namely, 
"scratch-marks," and these will be developed in direct 
ratio with the severity of the pruritus and the vulnera- 
bility of the skin. In addition to these we will find in- 
creased pigmentation, increased distinctness of the 
natural lines and furrows, and increased roughness, 
hardness, and thickness of the skin. The extensor 
surfaces of the limbs are the chief seats of the trouble. 
These phenomena may be embraced under the title 
of prurigo mitis, or vulgaris, but in exceptional cases, 
however, all the symptoms may be greatly aggra- 
vated, constituting the prurigo ferox of Hebra. The 
papules are larger, the excoriations more severe, and the 
papules may be torn open, giving exit to a little sero- 
purulent fluid; and a localized or general eruption may 
complicate, and to a certain extent mask, the primary 
affection. The whole surface becomes deeply pigmented, 
and the axillary and inguinal glands become enlarged. 

Prurigo, whether in a mild or severe form, is a chronic 
disease, occurring even in childhood, and lasting for life. 

The etiology of prurigo is unknown. The microscope 
throws about as much light upon the subject, as on many 
other cutaneous affections. Different observers obtain 
different results. The majority suggest the possibility 
of a connection with the sudatory apparatus. 



PRURIGO. 145 

Prurigo is mainly an affection of the poorer classes, 
and occurs mostly on the extensor surfaces of the lower 
extremities, but is frequently found on the forearms and 
trunk. It is aggravated during the winter months. 

Diagnosis. — The diagnosis of prurigo is not to be 
definitely made at the very beginning of the disease, but 
may be suspected in childhood when there is no other 
obvious cause for the pruritus. When, however, it has 
lasted for some years, this very fact is presumptive evi- 
dence; and the discovery of the peculiar papules, in con- 
nection with the scratch-marks and their location, should 
in the absence of complications enable the diagnosis to 
be made. 

The prognosis is bad, except when judicious treatment 
is instituted early in the course of the affection. 

Treatment. — Relief may be obtained by means of pro- 
longed baths and energetic frictions, and alkaline and 
tarry preparations, such as the tindura sapo7iis viridis, to 
which a liberal amount of tar has been added. Pepper- 
mint oil acts as a temporary sedative. As the violence of 
the disease is most fully displayed at night, the applica- 
tions should be made at bed-time, except in cases of such 
severity that the patient is obliged to abandon business 
or social life, and give himself up entirely to the treat- 
ment of his disease. 

Prurigo as a Family Affection. — Dr. SokolofF records 
the history of a family, in which, of six children (aged 
from I to 12), three (two girls and one boy) were suffer- 
ing from a severe general prurigo. In each instance, the 
symptoms had first appeared about six months after the 
child's birth to gradually attain their maximum intensity 
about the fifth year of the patient's life, after which the 
itching as gradually decreased. The symptoms were al- 
ways intensified during summer, and under the influence 



146 SKIN DISEASES. 

of heat in general. All the three patients were fair and 
fat, while those not affected were of dark complexion and 
lean. 

The following makes a very soothing lotion: 

^ Sodii hyposulphit, dr. j. 

Acid carbolic, dr. ss. 

Glycerini, ^j. 

Listerini, ^jjj. 
M. Sig.: Use as a lotion. 

lyOtions of bran water, or of Mezereum or Grindelia i 
part, water lo parts, will be useful in allaying the itch- 
ing, as will also Carbolic acid, gtts. v.; Aqua, ^j. In 
obstinate cases the use of sulphur vapor baths is com- 
mended. 

Indications for internal remedies are as follows: 

Aconite. — Furious itching all over the skin, with febrile 
symptoms, and especially with inflammation of the skin, 
thirst and restlessness. 

Arsenic. — Chronic form, itching and burning, better 
from warmth. Thirst, drinking little, but often, restless- 
ness. 

Belladonna. — Creeping, crawling itching, with burning 
and soreness. Aggravated about 3 p. m. Children with 
blue eyes, blonde hair, delicate skin and red complexion. 

Borax. — Child becomes pale, the flesh relaxed and 
withering, with crying, aversion to food, and awakening 
from sleep with screams. Whitish pimples with red 
areolae. 

Carbo veg. — Itching over the body day and night. 
Derangement of digestion with bloating of the abdomen 
and frequent eructations. 

Dolichos. — Intolerable itching all over the body, worse 
at night, preventing sleep, worse after scratching. 



PRURIGO. 147 

Ignatia. — Fine pricking itching, changing from one 
part to another. 

Mercurius. — Aphthous or eczematous prurigo. Itch- 
ing worse at night, and worse from warmth of the bed. 
Sweating easily, but without rehef. 

Rumex. — Itching better from warmth, contagious 
prurigo. 

Rhus ven. — Elevated red blotches, more on face, neck 
and chest, with violent itching. 

Sulphur. — Intense itching, worse in the evening and 
in bed, recent cases. Dry skin. Averse to washing. 



CHAPTER VIII. 

ECZEMA. 

Among the most common as well as perplexing cases 
of skin disease met with by the dermatologist and gen- 
eral practitioner, eczema justly occupies a prominent 
place, assuming as it does a multitude of forms, general 
and local, acute and chronic, and appearing so universally 
among all classes of society, the rich as well as the poor, 
the ignorant and the well educated, and arising from the 
most varied causes. 

An accurate and at the same time concise description of 
eczema is impossible, in view of the fact that the disease 
presents so many forms and phases, and that of a dozen 
consecutive cases no two may look alike, or even bear 
what ordinarily would be termed a family resemblance. 
These differences are due to the occurrence of lesions 
which may be quite dissimilar in character and appear- 
ance, and combined in ways and proportions almost with- 
out number. The aspect, too, of the individual lesions 
varies somewhat with the location they occupy, the de- 
gree of activity they present, and the length of time 
they have lasted. 

The varieties of eczema dependent on the primitive or 
characteristic lesion are six in number — namely, erythe- 
matous, vesicular, pustular, nudose, papular, and fissured; 
and these in their progress may undergo changes and be- 
come complicated with or give place to certain secondary 
lesions. 




Eczema Rubrum. 



ECZEMA. 149 

The varieties of eczema dependent on the activity of 
the process may be classed as acute and subacute, while 
those that run but a short course may also be termed 
acute, and those of longer duration chronic. 

Location greatly influences the appearances presented 
by eczematous lesions, and the principal modifications 
met with in this connection are those seen on the scalp, 
face hands and feet, genitals, and about the anus. 
Eczema may also invade the follicular apparatus of the 
skin, and give rise to an eczematous affection of the hair- 
follicles and of the sebaceous glands. 

We will best understand the appearances presented by 
this protein malady if we trace the course of a simple 
acute eczema of the general surface. It commences with 
a local congestion, or erythema, followed in a few hours, 
perhaps, by a crop of minute, closely aggregated vesicles 
filled with a clear, transparent serum. It often takes a 
sharp eye, and even a lens, to distinguish their separate 
contours. When closely examined, we find them to 
consist of a very thin and delicate epidermic covering, 
which for a brief period retains the lymphy exudation 
that is seeking an exit. Rubbing, scratching, or other 
violence from without, or the pressure of the exudation 
from within, soon ruptures the epidermis, and usually in 
twenty-four or thirty-six hours the vesicles have disap- 
peared, and we find in their place a red and exposed sur- 
face more or less moist with exudation. If exposed to 
the air, the watery portions of the exudation evaporate, 
and light, straw- colored crusts remain. As the exuda- 
tion continues, the crusts thicken until they drop off, or 
are purposely removed. After a varying period (days or 
weeks, as the case may be) the exudation diminishes, the 
crusts lessen or cease to form, and nature makes an 
attempt to cover the part with a new layer of horny epi- 



150 SKIN DISEASES. 

thelial cells. It may be weeks before this effort is en- 
tirely successful, and the affected surface presents in the 
interval a reddened and somewhat glossy surface scantily 
covered with loosely attached scales of small size, the 
scales being composed of embryonic horny cells which 
have not yet attained a normal character and consistence. 
Those first formed are less visable than the normal cell, 
and are quickly shed, to be replaced by others of more 
natural character and aspect, until finally we find a com- 
plete regeneration of the epidermis, and a return to the 
condition which existed before the appearance of the at- 
tack. In eczema pure and simple we never have ulcera- 
tion or loss of tissue, and recovery takes place without 
the least trace of scarring. 

For practical convenience the course described above 
may be divided into three stages : the first being that of 
congestion and vesicle formation, the second that of exu- 
dation and crusting, and the third that of dryness and 
scaling. 

The pustular variety of eczema pursues the same course 
and passes through the same stages as the vesicular, and 
differs from it only in the character of the exudation and 
the color of the crusts in the second stage. Instead of a 
transparent, lymphy exudation we have a purulent one, 
and the crusts are of a greenish color. In the vesicular 
form the number of leucocytes in the exudation is limited, 
while in the pustular they are abundant. The third 
stage of both varieties is identical, and if a case be seen 
in this stage it is impossible to determine, except by the 
patient's recital, whether the eruption had been charac- 
terized by vesicles or pustules. 

The nudose, or exfoliative form, differs from the pre- 
ceding forms by the fact that neither vesicles nor pustules 
are observed, but instead a rapid loosening and exfolia- 



ECZEMA. 151 

tion of the horny layer over the whole or greater part of 
the affected area. The succeeding exudation may be 
serous, sero-purulent, or purulent, and crusts form, as 
already described. In the second and third stages the 
appearances are the same as those presented by the two 
first-named varieties. 

In the papular variety an area of congestion becomes 
the seat of small scattered or aggregated papules, with 
little if any tendency to exudation, unless the papules be 
wounded by scratching. In this case a small quantity of 
lymph may exude and dry into a minute scale or lamina. 

The papules after a time subside and the surface be- 
comes somewhat glossy and scaly, but not to the extent 
met with in the varieties already described. The arms 
and forearms, and the thighs and legs, especially the 
flexor aspects, are the favorite seats of papular eczema, 
although it is sometimes met with on the face. 

In the Assured variety we have a more or less reddened 
surface without vesicles, pustules, or epithelial exfoliation, 
but instead presenting small cracks or fissures extending 
through- the stratum corneum, and sometimes through 
the stratum Malpighii as well. Exudation is slight, 
crusting is absent, and the skin after a time returns to 
the normal condition by simply closing of the fissures and 
disappearance of the congestion. The palms and soles 
are the favorite seats of this variet}^ 

The erythematous variety is characterized simply by a 
red and congested patch of varying extent, and is not ac- 
companied with vesicles, pustules, papules, or the other 
lesions of the disease. 

Cases of eczema vary in respect to the grade of inflam- 
mation present. In one it may exhibit great activity and 
be accompanied with decided heat, high color, and other 
evidences of marked inflammatory action, in either the 



152 SKIN DISEASES. 

first or second stages or in both ; and this activity may 
continue for an indefinite period, and until the case pre- 
pares to enter the third stage. On the other hand, the 
natural color may be but slightly altered, the increase of 
local heat be almost inappreciable, and the general pro- 
cess partake of a subacute character from the beginning. 
In other cases, again, an eruption which is subacute may 
at any stage of its progress suddenly assume an acute 
phase, or there may be frequent alternations of activity 
and comparative quietude. This is a very striking 
feature of eczema, and one that should always be borne 
in mind. A case may be progressing nicely under treat- 
ment, and with the prospect of early recovery, when sud- 
denly the trouble may relapse into its previous active 
state, and often apparently without sufficient provocation. 

The duration of eczema varies. In some cases it may 
run its course in a few days or weeks, while in others it 
may be prolonged for months or years, constituting the 
chronic form of the affection ; or, again, there may be 
frequent relapses, even after complete disappearance of 
the individual attacks. 

The locatio7i of an eczema greatly influences its appear- 
ance, and exhibits also preference for certain varieties of 
lesion. Thus, in eczema of the scalp, especially in in- 
fants and children, the process is usually acute, with pro- 
fuse lymphy or purulent exudation, which mats the hair 
together in a tangled mass, offensive to both sight and 
smell. If by chance pediculi find lodgment in such a 
scalp, they multiply rapidly, and by their irritation in- 
crease and aggravate the trouble. If proper care and 
cleanliness are not practiced, the scalp may become a 
mere mass of animated filth. 

When eczema attacks the scalp in children, it fre- 
quently extends to the face, and presents an active form 



ECZEMA. 153 

of inflammation of the vesicular, pustular, or nudose type, 
accompanied with a good deal of heat and pruritus. If 
it extends behind the ears, fissures may form. 

In adults, eczema of the scalp is usually of the subacute 
form, without much exudation ; and on the face it may 
be of the erythematous type, without other lesion. 

When the palmar and plantar surfaces are attacked by 
eczema, we may have a purely erythematous lesion, 
characterized by a red, dry, and glossy surface, on which 
the natural skin lines are greatly exaggerated as to size 
and distinctness, and many lines appear which are not 
noticeable in the normal condition. In addition fissures 
may form, accompanied with slight exudation. This 
type of the disease is the most common, and is usually 
subacute and chronic. On the other hand, we may have 
an acute eczema of the hands and feet, accompanied with 
vesicle formation. In consequence of the thickness of 
the horny epidermis on those parts, the vesicles do not 
easily rupture, but instead retain their integrity, and even 
become larger, and remain as vesicles until absorption of 
the contents occurs, when what was the summit of the 
vesicle separates as a small scale. 

The penis and scrotum usually exhibit the erythe- 
matous variety, vesicle and scale formation being rarely 
met with. 

The inner aspect of the thighs and legs is the favorite 
location of the papular form, although it may be met 
with on almost any part of the body, and even on the 
face. 

On the lower extremities below the knees eczema is 
frequently encountered as a direct result of varicose veins, 
and, if these latter have given rise to ulcers, a broad and 
difi"use zone of erythematous eczema will almost always 
surround them, with scattered patches on the neighbor- 
ing parts. 
II 



154 SKIN DISEASES. 

Eczema about the anus is frequently marked by radiat- 
ing fissures of greater or less depth. 

Eczema may extend from the skin proper down into 
the follicular openings, especially those of the face and 
other hairy parts, except the scalp. In these cases the 
surface eczema may play a very secondary part. On the 
one hand, we may have the hair-follicles especially in- 
volved. When this appears, the general surface of the 
patch will be found red, and either dry or exuding, but 
the inflammation having invaded the lining membrane of 
the follicles, they will be found swollen and loosened. 
Slight traction on the hair will extract it, accompanied 
with its root-sheaths. Frequently the exudation which 
forms within the follicle comes to the surface, and lifts the 
epidermis surrounding the hair, and forms a pustule 
(rarely a vesicle) pierced through the center by the hair. 
This deep-seated inflammation sometimes results in ex- 
tension of the action beyond the proper outline of the 
follicle, and nodules form. This condition must be dis- 
tinguished from sycosis, with nodules, etc., resulting 
from parasitic invasion. 

The sebaceous glands may also become the seat of 
eczematous inflammation, either with or without marked 
participation of the surface. Under the stimulus of the 
eczema the glands exhibit increased functional activity, 
and the eczematous exudation when present becomes 
mixed with the increased sebaceous secretion, and, instead 
of a purely lymphy or purulent exudate, we have some 
thin sebum mingled with it, which usually dries into 
greasy scales or crusts. 

When an eczema persists for any great length of time, 
and becomes chronic, we find additional features that are 
important both as regards description and treatment. 
The chief of these is infiltration. The skin is still red, 



ECZEMA. 155 

but usually dry, and appears to possess double or treble 
its natural thickness, and the patch is very appreciably 
raised above the surrounding surface. 

Dr. Taylor reports three cases of malaria accompanied 
by an eczematous eruption, both making their appear- 
ance simultaneously ; under proper treatment both con- 
ditions were relieved, the remedies given relieving both 
conditions. 

. Dr. Stettler reports an interesting case of vulvar eczema 
as a sequel of the climacteric period. 

The extreme prevalence of eczema makes its correct and 
certain diagnosis of the first importance ; and, if the 
rules laid down in the general chapter be closely followed, 
there need not, in the great majority of cases, be any very 
great difficulty. The history of the attack, the frequently 
multiple lesions, and their progress as observed or, as re- 
lated by the patient, should not leave the physician long 
in doubt. 

It is important, however, to distinguish a dry scaly 
eczema of the scalp in children from a condition some- 
times presenting very similar appearances, but due to an 
entirely different cause — namely, the vegetable parasite, 
tricophyto7i , which is the etiological factor of ringworm. 
In cases of doubt the microscope will decide by revealing 
the presence of the fungus. In like manner eczema of 
the hair-follicles of the face must be carefully distin- 
guished from ringworm of the same parts, to which the 
name of barber's itch is commonly given. 

Eczema sometimes resembles psoriasis, and psoriasis 
sometimes resembles eczema ; or, again, we may have an 
eruption which no one would be justified in pronouncing 
either one or the other from the appearance only. Usu- 
ally the history will enable us to decide. On the hands 
and feet we may have appearances which may present 



156 SKIN DISEASES. 

difficulties in diagnosis between eczema, psoriasis, and 
syphilis. 

Lastly, we have known a lichen planus to be mistaken 
for a papular eczema even by gentlemen well versed in 
cutaneous diagnosis. 

Etiology. — It may be regarded as almost axiomatic 
that the better we understand a disease the better we will 
be able to treat it. This is especially true as regards 
eczema. Occasionally cases of acute eczema will be met 
with that recover under the simplest application, and 
even under the influence of a plain, non-medicated dress- 
ing. Unfortunately, these cases are rare, and in the 
chronic forms it is often necCvSsary to avail ourselves of 
every possible aid to recovery. A thorough appreciation, 
therefore, of all the causes of the eruption, both actuating 
and contributing, can not fail to greatly assist the thera- 
peutist in the proper selection of the remedial agencies 
applicable to a given case. 

Eczema attacks more frequently light, florid-complex- 
ioned individuals, and is a commoner affection in this 
country than in Europe. Like the individual who makes 
a failure in life, eczema usually travels from head to foot 
as age advances. It appears more particularly on the 
head in infancy and youth, descends to the trunk and 
genitals as adult life approaches, and appears on the 
lower limbs as its victim is tottering to the grave. 

Among the exciting causes we may mention irritation 
of the skin by scratching, by friction of the clothing, by 
irritating ointments, by oils, by bandages, by artificial 
legs, trusses, etc., by hot baths, by too high a tempera- 
ture, by alternation of heat and cold, by heat and 
moisture, by the injudicious use of Turkish and Russian 
baths, by strong potash soaps, and by any exciting cause 
giving rise to hypersemia of the skin. In quite a number 



ECZEMA. 157 

of cases it seems to be hereditary. It is by no means a 
rare disease in those who are syphilitic, gouty or strumous. 

It is frequently dependent upon renal troubles, men- 
strual irregularities, dentition, dyspepsia and mal-assimi- 
lation, varicose veins and hemorrhoids. Undoubtedly 
perverted innervation, with general debility and morbid 
conditions of the blood, is an important cause. 

Overfeeding, the habit of feeding the child too fre- 
quently, and of allowing children who have passed the 
milk-diet period to eat frequently of inappropriate food 
between meals, will prevent the recovery of chronic cases, 
despite the administration of the well-selected remedy. 
When the tongue is coated, the breath foul, and the 
bowels constipated, the diet requires particular attention. 
Children kept in warm rooms where the air is vitiated 
are liable to suffer from this affection, especially if they 
catch cold easily from the least exposure. Allowing the 
child to sleep upon a very soft pillow, into which the head 
becomes buried at night, or feeding "bottle babies" 
with milk too warm, has seemed to aggravate some cases. 
Fresh air and sunlight, with attention to hygienic 
measures, will exert a favorable influence upon this 
stubborn disease. The diet must be carefully looked- 
after, and all sweets and confections be strictly pro- 
hibited. The sleeping apartments must be properly ven- 
tilated. Plenty of exercise in the open air must be 
taken. The clothing must be adapted to the season. 
Bathing sufficient to meet the requirements of cleanliness 
should be insisted on, but too frequent or too profuse use 
of water is not advantageous. The acute stage of eczema 
is very intolerant of water. If the surface is raw and 
discharging, water aggravates the condition. Water, 
however, is not to be absolutely excluded from the treat- 
ment of eczema. It not infrequently happens that very 



158 SKIN DISEASES. 

hot water — hot as it is possible for the patient to bear it 
— will cause immediate cessation of itching ; while in 
chronic cases, with considerable infiltration, systematic 
use two or three times a day of very hot water will often 
be followed with the happiest results. A full bath of 
tepid water, with a pound of sal soda added to it, and 
taken at night, will generally exert a soothing influence ; 
while in sluggish and chronic cases ten or twelve pounds 
of common salt added to a full bath will exert a stimu- 
lant action and tend to promote the cure. 

In all cases search should be made for all possible 
causes of local irritation, and the first care should be to 
remove them, if practicable. 

The diet of eczematous patients is of the first import- 
ance. No hard-and-fast general dietary laws can be 
adhered to. Bach patient must be treated according 
to his case, and at first be put upon as simple a diet 
as possible. When this basis is reached, the patient's 
taste is to be consulted and his diet made more varied, 
care being taken to avoid anything that is known to 
disagree with him. Sometimes, it is advisable to have a 
patient increase the number of meals in a day, while de- 
creasing the quantity of each one. Some patients do best 
on solid food alone, leaving out tea, coffee, and the like. 
Sometimes the best results are obtained by having the 
patient eat only one sort of food at a meal — whatever he 
fancies. In many cases of chronic eczema a liberal sup- 
ply of fluid is useful, and this not taken at once, but 
often in small quantities. Up to three quarts of water 
may be taken in this way. The addition of salt to the 
dietary is also useful. As a rule, you will find that adult 
sufferers from eczema are decidedly carnivorous in their 
tastes, eating a good deal of meat with a very scant 
quota of vegetables and cereals. Many of them are par- 



ECZEMA. 159 

ticularly fond of the pleasures of the table, and indulge 
much more freely than there is any necessity for. As 
these matters are under the control of the patient himself, 
no pains should be spared to impress on him the necessity 
for a change in his habits. It is not well to cut off the 
supph^ of meat absolutely, but it should be very decidedly 
restricted, and a larger proportion of bread, vegetables, 
and cereals substituted. 

Patients often fancy that diet of this sort will reduce 
their strength and incapacitate them for the amount of 
labor that their daily vocations necessitate. These fears 
are groundless, and on trial will soon be dissipated. 

A very interesting and important question has been 
raised as to the propriety of healing completely a dis- 
charging eczema, and the fear of driving in the disease 
has often deterred practitioners from affecting a speedy 
cure. 

Hebra and his school laugh at this idea, and no doubt 
in the majority of cases with good reason. 

The question at issue, whether an habitual discharge 
ma3" be suppressed without danger to a patient, depends 
upon the patient, and not on the disease. 

' ' I attended a child who had lost two younger brothers 
from acute tuberculosis. He had a very extensive ec- 
zema of the scalp and face, but otherwise appeared in 
good health. Under appropriate remedies his eczema 
rapidl}^ got well, but its disappearance was attended with 
all the signs of acute hydrocephalus, from which he soon 
died. 

With the family disposition to this disease, it is not 
unlikely that the child might have succumbed to tuber- 
culosis had the eczema not been cured ; but I fear my 
treatment was injudicious, as the child's disposition to 
disease of a special and serious kind was not taken into 
account." (Simon.) 



160 SKIN DISEASES. 

Analogies of the impropriety of rapidly suppressing 
habitual discharges are common enough. Hemorrhages 
from the lungs or stomach occur often enough when 
hemorrhoids, which have been bleeding for years, are 
suddenly cured, and cases have been recorded in which 
cerebral hemorrhage has seemed to follow rapid cure of 
an old ulcer. 

Local Treatment. 

The local treatment consists in first allajdng the acute 
inflammatory symptoms, if any exist, and involves the 
employment of various lotions, glyceroles, ointments^ 
oils, plasters, powders and soaps. It is not always an 
easy matter to say what will soothe in any particular 
case. Bran infusion, or decoction of marsh-mallow or 
poppy heads, to which a little clarified size has been 
added, are very good applications to start with as lotions 
night and morning. The linimentum aquse calcis is 
sometimes efiicacious. 

During the first and second stages the solution of the 
peroxide of hydrogen is of great value. The commercial 
article usually contains twelve volumes of the peroxide, 
and is too strong to apply in many cases of eczema, and 
may require dilution with one or two parts of water or 
even more. The effect of this solution in many cases 
appears almost magical, reducing the purulent exudation, 
and hastening the formation of a new epidermis. 

Dilute alkaline preparations, especially a solution of 
carbonate of soda, are useful for cleansing purposes, and, 
to a certain extent, for the relief of pruritus. 

Strong alkaline preparations, such as liquor potasses ^ 
green soap, and its tincture, have a distinct function to 
perform in the reduction of thickened epidermis, in 
eczema of the hands and feet and in the removal of infil- 



LOCAL TREATMENT. 161 

tration. If a patch of greatl}' infiltrated eczema be 
painted with liquor potassse, in a few moments little 
droplets of serum will be seen upon the surface. If that 
be wiped off, fresh serum exudes, and this continues for 
some minutes. When the tendency- to exudation ceases, 
the parts should be wiped dry and a sedative ointment 
applied. The application is repeated on the second or 
third da}', according to the degree of irritation produced, 
and this is continued until several applications have been 
made. The result will be a notable reduction of the 
infiltration. 

Should the itching prove obstinate, a weak carbolized 
oil and lime water lotion, or a grindelia robusta lotion, 
one drachm to the ounce of water may be used. 

The following lotion I have found very useful to allay 
the terrible itching present in some cases, and to soften 
the texture of the scalp and reduce the inflammation. At 
the same time give internally Lappa major 2x or 3X 
tablets: 

9^. Lappa major, ^jj. 

Glycerine, ^j. 

Aqua destillata, q. s. ad., ^iv. 
M. Sig. : Apply to scalp on retiring. 

Ointments. — The ointments most in vogue are the 
unguentum zinci oxidi, ung. hydrargyri ammoniati, ung. 
picis liquidi, and ointments containing carbolic acid, sali- 
cylic acid, and resorcin. Of these the zinc ointment is 
probably inert so far as any direct medicinal effect is con- 
cerned. It is simpl}' a protective, and as such serves an 
admirable purpose', especially in cases of extensive disease, 
where it would be neither safe nor prudent to employ the 
mercurial preparations. The addition of a little bella- 
donna increases its sedative effects. 



162 SKIN DISEASES. 

Unguentum hydrargyri atnmoniati, either alone or 
with the addition of a little stramonium, is much more 
effective as a curative agent than zinc ointment, but 
must be used with a certain amount of discretion, and 
should not be applied to a very extensive surface, lest 
salivation should occur. In some cases it irritates and 
should be abandoned, and in a few instances I have 
known it to excite an intense dermatitis. 

Ointments containing from four to ten grains of car- 
bolic acid to the ounce are sometimes of service for the 
relief of the distressing pruritus. 

The following makes an excellent application for the 
intense itching: 

^. Chloral hydrastis, 

Camph. pulv., aa dr. ss. 

Acidi carbolici, M. x. 

Balsam Peru, dr. j. 

Menthol, gr. xx. 

Ung. zinci oxidi, q. s. ad., ^ j. 
M. ft. unguent. Sig. : Apply morning and night. 

The second stage of eczema with exudation and crust- 
ing is the period when the above-mentioned ointments 
are of the most service. After removal of all crusts, and 
careful drying of the surface, the ointments may be 
smeared on the parts, or applied on muslin and bound on. 
The salve- muslins introduced by Dr. Unna, which consist 
of a loosely woven fabric thickly impregnated with the 
ointment, are exceedingly convenient when a fixed dress- 
ing is desired. The plaster-muslins of Unna have a 
firmer consistence, and are more generally useful than 
the salve-muslins. Similar dressings have been placed on 
the market, and fully meet all requirements. 

The frequency of the application or of the dressing 
will depend in great measure on the amount of discharge. 



LOCAL TREATMENT. 163 

Sometimes the applications will require renewal night 
and morning, and sometimes but once in twenty-four 
hours. As a rule the parts should be disturbed as little 
as possible, and the dressings removed only when 
necessary. 

Ungue?itum picis liquidi and ointments containing 
oleum cadinum, oleum rusci, and similar empyreumatic 
substances, play quite a different part in the treatment of 
eczema. They vshould never be used in the first or second 
stage of the disease, or when acute conditions are present. 
In the third stage, however, where the skin presents a 
dry and scaly surface, covered with newly but imperfectly 
formed epithelium, and especially if the affection is indo- 
lent, these preparations are of the greatest service. 

In inveterate cases, oil of white birch may be used 
in the form of an ointment, one-half to two drachms to 
the ounce of vaseline. 

Collodiofis. — Contractile collodion will sometimes avert 
a threatened eczema, and prevent extension from one al- 
ready existing, if applied around the margin of the lesion. 
Flexible collodion is a protective only, and may be useful 
when the exudation is slight. Cantharidal collodion is 
sometimes employed as an application to an old and ob- 
stinate local patch which it is desired to stir up to some 
degree of activity. Occasionally it hastens a cure — more 
frequently it does more harm than good. Collodion with 
five per cent, of iodine will often prove of service in 
chronic thickened patches, while collodion containing 
three or four per cent, of salicylic acid will dissolve and 
remove thickened epidermis from the hands and feet 
more quickly, perhaps, than any other substance. Sali- 
cylic acid, however, should never be used continuousl}^, 
or during the second stage, when the epithelium is ab- 
sent, as it tends to prevent the cornification of the new 
epithelium. 



164 SKIN DISEASES. 

Traumaticin is the name in common use to designate a 
ten per cent, solution of gutta-percha in chloroform, 
and it possesses many advantages over collodion, and 
may be made use of in connection with oxide of zinc, am- 
moniated mercury, etc. 

Gelatine, mixed with glycerine, and dissolved by heat, 
has been used as a basis for the incorporation of various 
drugs applicable to the treatment of eczema. When 
applied it should be liquefied by heat and painted rather 
thickly on the parts. It can only be used where patients 
are confined to the bed, and is not as useful, in my ex- 
perience, as other applications. 

Powders. — It is sometimes found that in the second 
stage of the disease ointments and lotions of every kind 
increase the irritation and add to the discomfort of the 
patient. Fortunately, these instances are rare; but when 
they are met with simple or medicated powders will 
sometimes prove of service. Starch, lycopodium, ordi- 
nary toilet powder, or talc, may be used alone, or the 
oxide of zinc or subnitrate of bismuth may be used with 
either of them. 

Soaps. — Soft potash soap, equivalent to the sapo 
viridis of the Pharmacopoeia, contains an excess of alkali, 
and is used for the reduction of infiltration. It should 
be thoroughly rubbed in with the aid of flannel moistened 
in hot water until a lather has formed. This is left on, 
and the effect is similar to that of liquor potassse, already 
noticed. Hard soda soap, prepared for laundry use, also 
contains considerable free alkali, and may be used for 
the same purpose. Tar soap is of service in the third 
and scaly stage of the disease. 

Certain mechanical means are sometimes employed in 
the treatment of eczema. The application of rubber, in 
the form of an elastic bandage, often proves of the great- 




-ECZEMA. 



TREATMENT OF ECZEMA. 165 

est service in thickened eczemas of the lower extremities ; 
then the object sought is steady pressure with a view to 
produce absorption of the infiltration. The silk elastic 
stocking may be used for the same purpose. 

Sometimes localized patches of eczema of long standing 
fail to yield to any of the ordinary means for their relief, 
and necessitate more vigorous interference. In this 
connection scarification is extremely useful, and patches 
of thickened eczema will sometimes disappear almost 
as if by magic after the use of the knife. 

Treatment of the Special Forms and Varieties of 
Eczema. 

Bearing in mind the general principles that underlie 
the treatment of all cases of eczema, we will consider the 
special varieties as influenced by age, degree of inflamma- 
tory action, locality, etc., commencing with eczema of 
young children. 

In eczema intertrigo, so common in the groin and nates 
of infants, absorbent cotton dusted with finely triturated 
powder • should be constantly applied, so as to come in 
contact with the inflamed surfaces and separate them. 
Boracic and salicylic acids, each one part to two of sub- 
nitrate of bismuth, and five of oxide of zinc, is a good 
powder. Camphor mixed with ointments or washes re- 
lieves itching. A two per cent, solution of acetic acid, or 
a one per cent, solution of aluminium acetate in water, 
frequently gives relief. Carbolic acid is very efficient for 
itching. 

In eczema of the scalp in children we frequently, and 
perhaps generally, find the case acute as regards its char- 
acter, though it may be chronic as regards the duration 
of time that it has existed. It is almost always presented 
to the physician in the second stage characterized by 



166 SKIN DISEASES. 

exudation and crusting, and complicated with enlarged 
glands at the back of the neck, small abscesses of the 
scalp, and may also be accompanied with pediculi. The 
vesicular and pustular forms are the most common, and 
the crusts, entangled in and retained by the hair, accu- 
mulate more thickly than elsewhere. The first thing to 
do is to cut the hair off as short as it is possible to do it 
with scissors. If pediculi are present, search through 
hair stumps for their ova, which should be removed. If 
many crusts adhere to the scalp after clipping the hair, 
saturate the parts with olive oil, and, after a few hours, 
give the scalp a good washing with soap and warm 
water. After thorough drying, apply zinc or diluted 
white precipitate ointment. The ointment should be 
applied thickly, and renewed daily and even twice daily, 
and accumulations of old ointment be removed by gentle 
use of the comb as often as necessary. The scalp should 
not, however, be washed again for several days ; in fact, 
the less frequently it is washed the better. If abscesses 
are present, they must be opened, and perhaps poulticed 
for a day or two,. Eczema of the scalp, in many cases, 
seems to be called into existence as a consequence of 
parasitic irritation; and when the eczema itself is of but 
limited extent, but the parasites are numerous, they may 
be made the first point of attack and cutting of the hair 
be avoided. I know of nothing more effective than 
drowning them out with ordinary kerosene. If the hair 
be thoroughly saturated with this for two or three days 
in succession, soap and water, and a fine-tooth comb and 
patience will do the rest. The parasites destroyed, the 
eczema may recover spontaneously, or more quickly if 
aided with a few applications of ointment. 

The enlarged glands at the back of the neck require no 
special attention. When the eczema gets well they will 



TREATMENT OF ECZEMA. 167 

subside. Eczema of the scalp often extends to the fore- 
head, face and ears. If fissures form behind the ears, it 
is well to add a little finely-powdered graphite to the 
ointment. As the case progresses toward recovery, and 
the exudation and crusting cease, and the third stage, 
characterized by dryness and scabs, is ushered in, the 
treatment requires a change. 

A little tar, in some of its forms, should then be added 
to the ointment, and the proportion of tar gradually in- 
creased as improvement occurs. If progress toward re- 
covery should halt, a little more active stimulation may 
be the thing needed. If, however, the eruption should 
revert to the second stage, as not infrequently happens, 
the latter treatment will have to be resumed. 

Eczema of the scalp in adults presents itself more 
frequently in a subacute than an acute condition, and 
very commonly in the dry and scaly stage, the patient 
complaining of a certain amount of irritation and an ex- 
cessive formation of dandruff. If the same condition 
should be present on the non-hairy parts, tar would be 
thought. of as a remedy. This, however, is practically 
impossible on the scalp, except for those who are able to 
abandon social and business pursuits. As a substitute 
for tar Dr. Piffard recommends the following mixture as 
equally efficacious, and at the same time free from the 
objectionable features of the other. I can endorse his 
claim. 

9^. Acidi salicylici, gr. x to xx. 

01. lavendulse, ^iij. . 

Ol. citronellae, ^j. 

Ol, eucalypti, ^ij. 

01. ricini, |jj. 
M. 

In this preparation the salicylic acid is designed to re- 
strict the formation of scale, the eucalyptus to act as a 



168 SKIN DISEASES. 

Stimulant, and the castor oil to correct the drying effect 
of the latter. The best way to apply it is from a small 
oil can. The hairs having been separated, a few drops 
are applied directly to the scalp and gently rubbed in 
with the finger. All the affected portions are gone over 
in this way. To make the application in the most thor- 
ough manner the patient will, of course, need assistance. 
If care be taken, onl}^ so much oil as may be necessary is 
applied to the scalp, and the hairs, except near the sur- 
face of the scalp, do not become disagreeably impregnated 
with it. This application should at first be made daily ; but 
at the expiration of a week the intervals may usually be 
lengthened. If at any time the condition should revert 
to the second stage, with exudation and crusting, the oil 
must be discontinued, and white precipitate or zinc oint- 
ment substituted. Although I have devoted considerable 
space to the local treatment, I do not wish it understood 
that this is the most important ; it is simply one of the 
means to effect a cure. The internal, constitutional 
treatment is, by far, the more important ; they must go 
hand in hand to procure the best results. 

Eczema barbcB. — In eczema of the hairy portions of the 
face, the disease not infrequently descends into the hair- 
follicles, and especially involves the root-sheaths, and may 
be accompanied with considerable infiltration of the tis- 
sues between the follicles. The most frequent form is 
the pustular, each pustule being pierced by a hair. 
When the hair is extracted, it is generally accompanied 
with the root-sheaths, w^hich are swollen and loosened 
from the follicle. It is of the first importance that this 
affection be not mistaken for tricophytosis . 

If the eczema be purely superficial — that is, if the in- 
flammation has not descended into the follicles — it may 
be treated very much as an eczema situated elsewhere. 



TREATMENT OF ECZEMA. 169 

If, however, it is sycosiform in character, with infiltra- 
tion and pustules, epilation must be performed. Every 
hair in the affected region must be plucked out with 
forceps. As a rule, they come out easily and without 
much pain, in consequence of the loosening of the root- 
sheaths. The necessity for epilation will be apparent 
when we consider the fact that the loosened bairs, while in 
the follicles, are, to all intents, acting as foreign bodies, 
and thus tend to keep up the inflammation. After epila- 
tion, white precipitate or zinc ointment should be applied 
two or three times a day . 

Eczema of other hairy parts — axillae, pubes, etc. — 
does not usually take on the sycosiform character, and 
epilation may be unnecessary. 

Eczema of the genital region frequently presents itself 
as a chronic affection of the scrotum ; and most of the 
cases will have existed for j^ears before consulting the 
phj^sician. The parts will usually be found red, dry, and 
thickened, and the seat of more or less pruritus. In 
long-standing cases there are usually decided infiltration 
and thickening of the skin. Of all forms of eczema this 
is the one which is the most difficult to control. One 
writer disposes of the question of treatment in the follow- 
ing words: 

*'The treatment of eczema of the genital organs and 
anus does not differ from that of eczema in general, ex- 
cept in so far as we must bear in mind the predisposing 
causes, and endeavor to remove them if possible." 

This general advice is good as far as it goes, but per- 
haps the most important of the predisposing local causes 
is the dependent position of the parts, and their constant 
exposure to friction, to say nothing of the natural 
moisture of the parts. As these causes can not be con- 
veniently removed, w^e must confine ourselves to a partial 

12 



170 SKIN DISEASES. 

mitigation of their effects. This can be accomplished, 
so far as the scrotum is concerned, by a properly-fitting 
and snugly-applied suspensory bandage. The bag should 
be applied in such a way as to keep the parts as elevated 
as possible, and with as much pressure as can be con- 
veniently borne — without, however, constricting the 
upper part so as to impede the venous circulation. If 
there is much infiltration, the first efforts should be to- 
ward its reduction. There are three principal methods 
by which we may seek to accomplish this end; First, by 
a few scarifications of the scrotum, permitting the parts 
to bleed freely, care being taken not to cut any of the 
larger veins. After scarification the patient should sit 
for some minutes in a warm antiseptic sitz-bath to en- 
courage bleeding and exudation. After the parts are 
dried, a little tincture of benzoin or other antiseptic 
lotion may be sprayed over them, and the suspensory ap- 
plied. In a week or two the scarifications may be re- 
peated. The relief afforded by this is sometimes sur- 
prising. Many patients, however, have such a dread of 
cutting operations about the genitals that some other 
procedure must generally be advised. The second means 
that we have is galvanization. The constant current, 
applied daily or on alternate days, will sometimes reduce 
the infiltration and relieve the itching. The testicles 
should be pushed well up, and the scrotum held between 
two good-sized sponge-covered electrodes, and a current 
of eight or ten cells passed for five to ten minutes, the 
strength and duration of the current being regulated ac- 
cording to the susceptibility of the patient. The third 
method of reducing the infiltration is the one most com- 
monly employed, and consists in the application of liquor 
potassae. This should be mopped on with a small tuft of 
absorbent cotton wrapped around the end of a stick. 



TREATMENT OF ECZEMA. 171 

This application should be made by the surgeon himself, 
and not intrusted to the patient. After its immediate 
effects have passed off the parts ma}^ be dressed with zinc 
ointment and the suspensory adjusted. From six to a 
dozen applications, made at intervals of four or five days, 
will frequently produce very marked reduction of the in- 
filtration. Eczema of the penis, however, may exist 
alone, and if met with in persons passed middle life, and 
especially if the glans and inner surface of the prepuce is 
involved, the presence or absence of glycosuria should be 
ascertained. If this condition is present, the parts should 
be carefully washed after urination if the water comes in 
contact with them and an antiseptic lotion or powder ap- 
plied. The general treatment should be that which is 
appropriate to the diabetic condition. 

Eczema in the vulva is rarely met with until the cli- 
macteric or later. In some cases it is doubtless excited 
by irritating uterine or vaginal discharges, but in perhaps 
the majority it is due to glycosuria. In either case the 
preliminary treatment is clear, and, probably, the best 
local application is the peroxide of hydrogen. 

Eczema of the /^^/^t?^?' and />/<2;z^'<2r surfaces, frequently 
accompanied with great thickening of the epidermis and 
with fissures, requires special treatment. 

The thickened epidermis must be removed mechanic- 
ally with knife, file, or sand-paper. After all that is pos- 
sible has been removed in this waj^, a five per cent, solu- 
tion of salicylic acid in flexible collodion should be 
applied. After several daily applications have been 
made, it will be found that still more of the epidermis 
may be easily removed. If infiltration be present, liquor 
potassae should be applied, taking care not to let it get 
into the fissures, if any be present. The fissures them- 
selves should be dressed with graphite, and white pre- 



172 SKIN DISEASES. 

cipitate or citric ointment applied to the entire diseased 
surface. 

If, however, there be Uttle infiltration or epidermic 
proliferation, tar or its equivalent is indicated if the sur- 
face is dry and scaling ; while some of the less stimulat- 
ing ointments should be applied if the surface be moist 
and exuding. At best, eczema of the hands, if already 
chronic, is an exceedingly obstinate affection, and one 
difficult to remove. 

Eczema of the leg is very frequently dependent on pre- 
existing varicose veins, and when such is the case is 
difficult to manage, unless the diseased veins can them- 
selves be brought under control. If the varicose condi- 
tion be at all severe, the general nutrition of the skin of 
the leg seems to suffer greatly, and a slight wound from 
scratching may degenerate into an ulcer. The cutaneous 
tissues, which are the site of the lesion, and for a consid- 
erable space around it, may be greatly thickened, and the 
surface present a bluish tint from impeded circulation. 
When this condition exists, the utmost benefit will be 
secured from the systematic use of the rubber bandage 
applied so as to bring firm but even pressure to bear upon 
the parts. The bandage should, in the first instance, be 
applied by the physician, and the mode of its application 
taught the patient. The bandage should, when practic- 
able, be applied morning and night, and, if it becomes 
soiled by discharges of any kind, should be replaced by a 
fresh one, while the first one is permitted to soak in cold 
water till again needed. After the leg has been restored 
to its natural size, the bandage may be discarded, but an 
ordinary eclastic stocking should be worn habitually. 
The direct applications to be made will depend on the 
stage of the eruption and condition of the lesion. 



TREATMENT OF ECZEMA. 173 

Eczema of the leg, however, is not always of varicose 
origin, but sometimes presents itself as a chronic subacute 
circumscribed lesion, with or without much infiltration. 
If scaling be a notable feature — that is, with decided epi- 
dermic thickening and proliferation — a few applications 
of salicylic acid will prove of great service as a prelimi- 
nary application, and a ten or fifteen grain solution in 
flexible collodion should be painted over the spot. This 
may be repeated a few times until the tendency to scale 
formation has notably diminished. If there be but little 
infiltration, tar, or some of its preparations, is indicated ; 
but if infiltration is marked, potash or scarification should 
be employed and afterward zinc or white precipitate 
ointment. 

Acute eczema of the leg requires different treatment. 
If the greater part of the leg or both legs are involved, 
rest in bed or on a lounge, with the limbs elevated, is a 
sine qua non. The parts, being inflamed, hot, red, 
swollen, and exuding, need rest and soothing treatment. 
Absolute rest must be insisted on, and when secured 
apply a diluted solution of peroxide of hydrogen. The 
best method of applying it is with an atomizer. Purulent 
exudation is brought under immediate control, and of- 
fensive odors are destroyed. After two or three days, as 
a rule, the inflammation will be lessened, the area of de- 
nuded surface diminished, and attempt at healing be 
apparent. Now, some of the medicated plasters contain- 
ing oxide of zinc or ammoniated mercury should be ap- 
plied. These may be left undisturbed for several days, 
and if covered with an elastic stocking the patient may 
be permitted to take moderate exercise. If no indiscre- 
tions be committed, steady progress toward cure may 
usually be expected. 



174 SKIN DISEASES. 

Eczema of the inner surface of the thigh not unfre- 
quently appears in the papular form, and may best be 
treated with permanently attached dressings containing 
zinc or white precipitate. 

Eczema of the anus is an insiduous affection, and is 
frequently of long standing before it is brought to the 
notice of the physician. Thickening and fissures often 
coexist, and should first be treated and healed by cau- 
terization, peroxide of hydrogen, graphite ointment, or 
powder, etc., before any attempt is made to reduce the 
infiltration by strong alkaline applications. One of the 
most effective applications to the fissures is the fine point 
of a Paquelin cautery at a white heat. 

Eczema of the mammae and nipples is a very frequent 
accompaniment of scabies in the female, and when met 
with the latter disease should be suspected and sought 
for, and the scabies, if present, receive the first attention. 

In obese persons an eczema may arise from the irrita- 
tion produced by the confinement of the cutaneous secre- 
tions by overlapping folds of skin, as under pendulous 
breasts and in the groin between the thigh and genitals. 
In these, simple dusting powders, with separation of the 
parts by linen, will often accomplish all that is required. 

We now come to the consideration of the most import- 
ant of the means of cure of eczema, and one in which 
Homoeopathy has won some of her brightest laurels, — the 
internal treatment. 

Indications for the remedies are as follows: 

Aconite. — Acute eczema in plethoric persons. 

Al2imina. — Dry, thin subjects and old people with 
constipated bowels ; the slightest bruise of the skin 
smarts ; brittle nails ; much itching with no relief from 
scratching ; the patient feels as if the white of ^%% had 
dried on the surface ; itching aggravated in the evening 



TREATMENT OF ECZEMA. 175 

and from the heat of the bed, and every other day ; and, 
in the open air. 

Ammon. carb. — Eczema in the bends of the extremities ; 
excoriations between the legs, and about the anus and 
genitals ; violent itching relieved by scratching. Aggra- 
vated by either cold applications or hot poultices ; in 
children. 

Ammon. mur. — Eczema on the face and across the 
loins ; intense burning, somewhat relieved by cold appli- 
cations ; constipation ; in fat, sluggish individuals. 

Anacardium. — Acute eczema on the face, neck and 
chest. Tubercles on the scalp, sore when touched ; vio- 
lent itching, worse at night, and after scratching ; redness 
of the skin with eruption of small vesicles ; rough, ex- 
foliating skin around the mouth, burning around the lips 
as from pepper ; sensitiveness to draught. 

Antimon. crud. — Eczema with gastric derangement ; 
violent thirst ; white coated tongue ; yellowish, tenacious 
discharge ; violent itching ; aggravated from wet poul- 
tices, from bathing and working in water, from alcoholic 
drinks and in the sun. 

Antimo7i. tart. — Pustular eczema with bronchitis ; vio- 
lent itching, suppurative rash, particularly on the occiput, 
chest and arms ; sleepiness with nausea ; rattling cough ; 
irritable ; wants to be carried ; complains when touched. 

Apis. — Eczema with renal troubles, scanty urine, no 
thirst; tendenc}^ to dropsical swellings; burning and 
stinging in the skin ; aggravated from heat, ameliorated 
from cold water and scratching. 

Argent, yiitr. — Eczema on the genitals ; urging to 
urinate ; in children who eat too much sweets. 

Arse?!, alb. — All forms accompanied by intense burn- 
ing of the skin ; fetid or purulent discharge or dry, scaly 
eruption ; falling out of the hair in patches here and 



176 SKIN DISEASES. 

there, leaving the skin dry and dirty looking ; dry, 
parchment-like skin ; thirsty, drinking little and often ; 
aggravated after midnight, from cold, in open air and 
from scratching with bleeding afterward ; ameliorated 
from heat. 

Arundo Maui'it. — Eruption on the chest, upper ex- 
tremities and behind the ears. Intolerable itching, 
crawling sensation, especially over the loins and shoul- 
ders ; in young children. 

Astacusfluv. — Thick crusts on the scalp ; enlargement 
of the lymphatic glands ; clay colored stools. 

Aurum. — Old persons with mercurial symptoms; sui- 
cidal tendencies ; constant desire to be in the open air 
even in bad weather. 

Baryta carb. — Eczema capitis, wdth falling out of the 
hair and swelling of the adjacent glands ; fat, dumpy 
children ; timidity in the presence of strangers ; chronic 
disposition to swelling of the tonsils or glands of the 
neck ; takes cold easily ; aggravation at night and from 
scratching ; ameliorated when walking in the open air. 

Bellad. — Eczema on the face with scarlet redness, 
burning, itching eruption, sensitive to the touch ; in 
teething children, with tendency to convulsions ; over- 
sensitive, excitable persons. 

Borax. — Eczema on the face and scalp ; red, papulous 
eruption around the cheeks and chin ; excoriating secre- 
tions ; aphthous difficulties ; slight injuries suppurate ; 
dread of slight downward motion. 

Bovista. — Eczema about the mouth and nostrils ; gen- 
eral lassitude, especially in the joints ; patient wants to 
urinate immediately after micturition ; constipation ; 
perspiration smells like onions ; aggravated from warmth ; 
grocers' itch; moist vesicular eruption with formation of 
thick crusts; eruption on the thighs and bends of the 



TREATMENT OF ECZEMA. 177 

knees; on the back of the hand; swelling of the upper 
lip; burning, itching; no relief from scratching; symptoms 
worse during hot weather; the skin of the fingers becomes 
dented by the use of the scissors or other instruments. 

Bro7nine. — Profuse oozing of a dirty, nasty-smelling 
discharge; eczema covering the head as with a cap; crawl- 
ing sensation beneath the scalp, with sensitiveness to the 
touch; glands of the neck hard and swollen; high-colored 
urine. 

Bryojiia. — Eczema capitis when the scalp is ver)^ tender 
to the touch, and there are pains and aches worse from 
motion; eczema all over the body, especially on the back ; 
eruption slow in making its appearance; symptoms worse 
from exposure to the heat of the fire; stools dry and hard 
as if burnt. 

Calcarea carb. — Chronic and squamous eczema in 
scrofulous persons; skin inclined to ulcerate; itching and 
burning in the skin; thick crusts with oozing; parts 
affected — nape of neck, head, face, on and behind the 
ears, genital organs, region of umbilicus, hands and 
bends of the extremities; chalky stools; menses too soon 
and too profuse; takes cold easily; cold feet, as though 
there were damp stockings on them; no dread of water, 
but the disease is aggravated by water; aggravated in 
the open air and from water and from drinking milk; 
ameliorated in a warm room; in big-bellied children with 
light hair and blue eyes; profuse sweating of the head. 

Caladium. — Eczema alternating with asthma; great 
disinclination to move; vertigo on going to sleep; eczema 
of vulva, chest and forehead; ameliorated when pertjpiring. 

Cantharis. — Eczema with urinary difficulties; much 
burning and smarting or burning itching; aggravated 
from touch; ameliorated from lying down. 



178 SKIN DISEASES. 

Carbo veg. — Eczema with hemorrhoids and flatulency; 
the most innocent food disagrees; cachectic individuals; 
aggravated from warmth and water. 

Carbolic acid. — Moist vesicular eruption on the hands 
and all over the body. Itching better from rubbing, but 
leaving a burning pain. 

Causticum. — Eczema in rheumatic or gouty individuals; 
moist eczema on the neck and around the nipple; thick 
crusts on the nostrils; great restlessness; child is afraid at 
night in a dark room; aggravated in the open air and in 
the evening; ameliorated from the warmth of the bed. 

Chamom. — Excoriations between the thighs in children 
and infants; unhealthy skin, every injury suppurates; 
severe itching of sweating parts; child fretful, must be 
carried about. 

Chelidofi. — Eczema rubrum of the scrotum, or ankle; 
heat, swelling and redness of the parts; bitter taste in the 
mouth when not eating or drinking; pain in the hepatic 
region ; chronic affections of the abdominal organs. 

Cicuta. — Thick, whitish scurfs appear on the chin and 
upper lip; they secrete a dampness; sometimes affect the 
nose; no itching; the exudation dries down into a hard, 
lemon-colored scab. 

Clematis. — Red and humid eruptions when the moon 
is increasing, growing pale and dry with the decrease; 
scaly spots with yellowish corrosive ichor; pustules 
over the whole body; eczema, following suppressed gon- 
orrhoea; sticking sensation when touching the skin; ag- 
gravated from washing and from the heat of the bed. 

Conium. — Eczema of old people from being overheated; 
on face, arms and mons veneris; urine flows, and stops 
and flows, and stops at each emission; vertigo when 
turning the head, when looking up or when turning 



TREATMENT OF ECZEMA. 179 

over in bed; gluey, sticky discharge; aggravated from 
scratching. 

Cornus alternifolia. — Dr. Lutze reports on the use of 
the swamp wahitit, and sums up the following as indica- 
tions for the remedy: Eczema when the skin was cracked 
everywhere, but especially where it had a fold or crease, 
exuding a sticky, watery fluid from these cracks; use 
locall}^ and internally. 

Creosote. — Eczema capitis and mammae, with violent 
burning after scratching; heavy scabs. 

Crotalus. — Vesicular eruption on the septum narium; 
sour, acrid eructations; painful retention of urine. 

Croto7i tigl. — Any form of eczema uncomplicated with 
disease of other organs; watery diarrhoea gushing out 
forcibly; excessive itching, but the patient cannot bear to 
scratch very haid as it hurts; a mere rub sufi&ces to allay 
the itching. 

Co7idurango. — Especially when rhagades are present, 
oozing out a fetid fluid; cachectic or syphilitic dyscrasia. 

Cuprum. — With convulsions, or when convulsions fol- 
low the suppression of eczema. 

Cyclamen. — Eczem.a faciei; when there is stinging itch- 
ing, aggravated in the evening in bed by eating fat food, 
and ameliorated by scratching or by wiping with the 
hand. 

Dulcamara. — Eczema on the face and extremities 
preceding the menses, oozing a water}^ fluid and bleeding 
after scratching; after its disappearance, faceache and 
violent asthma; desire for cold drink, eructations, vomit- 
ing in the morning; persons who get angry easily; ag- 
gravated in cold weather, after taking cold, from cold, 
and evening when at rest; ameliorated while moving in 
warm air. 



180 SKIN DISEASES. 

Fluoric acid. — Eczema on the face, scalp, neck and 
chest; dry eruption with itching and burning; painful 
rhagades after washing; brittle nails. 

Graphites. — Thick crusts and a raw surface with deep 
rhagades; eczema of fat people, of blonde complexion 
who take cold easily; on and behind the ears with con- 
stant profuse oozing of a sticky fluid; thick crusts some- 
times ; falling out of the hair; on the face and chin, with 
considerable itching and increased discharge after scratch- 
ing; on genitals and in bends of limbs, especially of 
women with delayed and scanty menses; humid eruption 
with secretion of corrosive serum smelling like herring 
brine; great soreness of the skin, after scratching, with 
oozing of a sticky moisture; on the hands, with sticky 
and profuse secretion; itching worse in the evening and 
at night; skin dry, never perspires, and is inclined to 
crack; disease apt to become purulent; aggravated from 
cold and in the evening; and, when at rest. 

Helleb. — Eczema of the fingers, lips or head, continuing 
moist for a long time and then covered with scurf. Ag- 
gravation of symptoms from 4 to 8 p. m.; in the evening, 
in cold air, ameliorated in warm weather. 

Hepar. — Eczema pustulosum, with glandular enlarge- 
ments, severe itching and scratching, oedematous swell- 
ings; eczema behind the ears and on the scalp, burns and 
smarts after scratching, and is very sensitive to the touch; 
after the abuse of mercury; sleeplessness after midnight; 
aggravated at night, from cold air and from contact; 
ameliorated from wrapping up warmly. 

Hydrocya7iic acid. — Itching, burning vesicles on neck 
and arms; weakness and anaemia; constant drowsiness. 

Hydrastis. — Eczema along the border of the hair in 
front; aggravated on coming from the cold into a warm 
room; oozing after washing; constipation with hemor- 
rhoids. 



TREATMENT OF ECZEMA. 181 

Hypericum. — Eczema on the face and hands; yellowish- 
green crusts with violent itching; excessive itching, espe- 
cially in the sacral region when undressing; the eruption 
is sometimes dry, and at times fiery red; roughness of 
the skin. 

Iris vers. — Eczema on the face; pustular eruption 
around the nose and lips, and on the cheeks; worse in 
the evening and at night; gastric and bilious derange- 
ments. 

Juglans cin. — Vesicular eruption on the upper and 
front part of the chest with burning and itching; violent 
itching over the whole body, in spots, worse when being 
heated from over-exertion; stitch-like pain under the 
right scapula. 

Kali carb. — In persons inclined to pulmonary difficul- 
ties; take cold easil}^- sensitive to cold; sticking pains 
all over; eruption dry at first, but when scratched 
exudes a moisture; comes on in warm weather; puffy 
and baggy swelling of the upper eyelids (Ars., lower 
lids); great dryness of the skin; deficient perspiration 
(Graph.; Alum., Led.); yellow, scaly, violent itching 
spots over the body, especially over abdomen and around 
the nipples. Aggravated between 2 and 3 A. m., from 
cold air {Hep.), from becoming cold. Ameliorated in 
warm air and on getting warm. 

Lachesis. — Very obstinate cases when seated on the 
legs; ulcers on the lower extremities; pricking, pulsating 
tearing pains; variable appetite; burning in the palms 
and soles; often useful in women during the climacteric 
period. 

Lappa maj. — The lesion is at first vesicular, then a 
scurf, and afterward a greenish-yellow crust, and is 
always accompanied with such intolerable itching that 
the child has to be tied or mittened to keep it from maim- 



182 SKIN DISEASES. 

ing itself; sometimes the crust comes off in large patches, 
leaving the surface raw and exposed; the eruption smells 
offensive; swelling and suppuration of the axillary glands; 
disposition to boils. I have cured some very bad cases 
with this remedy, used as follows: Internally I use the 
IX three times a day, and apply locally the following 
lotion: 

^. Lappa major, ^ij. 
Glycerine, ^j 
Aqua destillata, q, s. ad ^iv. 

M. Sig. : Apply to scalp on retiring. 

Ledum, — Eczema only on covered parts; eczema of 
rheumatics or drunkards; gnawing, itching of the skin; 
the pain commences in the feet and goes up; aggravated 
from heat and motion, and heat of the bed. 

Lycopodiiim. — Obstinate cases when the eruption bleeds 
easily and has a thick, badly smelling discharge; 
parts affected — back of head, face, neck, hands and right 
fore-finger; bowels constipated; no appetite, a few 
mouthfuls satisfy him; great debility while at rest; bleed- 
ing after scratching; humid suppurating eruption, with 
thick crusts and profuse fetid discharge underneath; ag- 
gravated from 4 to 8 p. m. , after getting heated, and from 
wet poultices; ameliorated from cold, from uncovering 
one's self. 

Mercurius sol. — All forms of eczema, especially of the 
hairy parts in persons who perspire easily, but obtain no 
relief from perspiration; tendency to inflammation of the 
lymphatic glands; increase of saliva; enlargement of the 
tongue, showing the imprints of the teeth; scorbutic 
gums; after scratching, bleeding and smarting; sleepless- 
ness before midnight; aggravated at night; after getting 
warm in bed; after scratching; ameliorated in the morn- 
ing. 



TREATMENT OF ECZEMA. 183 

Mercurius iodat. — When other remedies fail and there 
is a decided syphilitic taint; swelHng and induration of 
the glands; troublesome itching over the whole body; 
all symptoms are worse at night. 

Merc, precip. rube7\ — Eczema of the hairy parts, and 
of the anus with fissures; eczema of the umbilicus; pustular 
eruption with slight itching: oozing of pus from beneath 
the crusts; glandular swellings. 

Mezeretim. — Eczema crusts with white scabs, itching 
intolerably, bleeding and burning like fire on being 
scratched; honey-like scabs around the mouth; dis- 
charges profuse, excoriating the surrounding parts; head 
covered with a thick, leathery crust, under which pus 
collects and mats the hair; constant chilliness; pale urine; 
thirst, but drinks only a little at a time. Scrofulosis. 

Natrum mur. — Eczema behind the ears, back of head 
and neck about the edges of the hair, anus, bends of the 
knees and elbows; humid eruption, with gluey discharge, 
matting the hair; raw, inflamed surfaces, with constant 
corroding discharge, which eats away the hair; craves 
salty food; difficult expulsion of stool Assuring the anus, 
with flow of blood; morning headache; cutting in the 
urethra after micturition; white, coated tongue; lips and 
corners of the mouth ulcerated and cracked; eyelids 
raw and ulcerated; aggravated in the forenoon and from 
exercise; ameliorated after lying down. 

Natrum sulph. — Very moist eruptions, with much 
oozing of fluids, the secretions more watery than sticky. 

Nitj'ic acid. — Eczema of gouty origin, about the head, 
ears and genitals; pustular eruption of the face, with large 
red margin, and heavy scabs; vesicles on the inner side 
of the left hand; soreness of the feet from profuse, offen- 
sive perspiration ; dry, scaly skin; moisture and itching 
in the anus; syphilitic ulcers after abuse of mercury; 



184 SKIN DISEASES. 

swelling of sub-maxillary glands; strong smelling urine; 
in dark-complexioned old people; aggravated at mid- 
night. 

Nux juglans. — Burning itching vesicles upon a cracked 
surface, with a greenish discharge which stiffens the 
linen; numerous, large, painful boils; itching worse in 
the evening and at night. 

Oleander. — A humid, scaly eruption of the scalp, with 
gnawing itching, temporarily relieved by scratching, soon 
followed by burning and increased itching; smooth, shin- 
ing surface, with drops of serum standing out here and 
there; humid fetid spots behind the ears, red, rough spots 
in front; very sensitive skin; it becomes sore, raw and 
painful merely from friction of the clothes; aggravated 
when undressing. Marked weakness of the lower limbs, 
and a gloomy irritable mental state. 

Oxalic acid. — Exceedingl}^ sensitive skin, with vesicu- 
lar eruption. Suffers from the use of sugar, and sweets 
in general. All symptoms worse while thinking of them 
(reverse, Camph.^. 

Petroleum. — Eczema with red, raw, moist surface; 
burns like fire; great itching; oozing after scratching; 
ulceration after scratching; small wounds spread and 
ulcerate; obstinate dry eruption on genitals and peri- 
nseum, inside of thighs; skin of the hands cracked and 
rough; eruption between the toes; skin heals with diffi- 
culty; aversion to open air; aggravated in the open air 
and during a thunder-storm; ameliorated from warmth 
and warm air. 

Phosphorus. — Dry eruptions, burning and itching; the 
gums separate from the teeth and bleed easily; ecchy- 
mosed spots on the body; slight wounds bleed much, ag- 
gravation at night before midnight; during a thunder 
storm; ameliorated after scratching; after sleeping. 



TREATMENT OF ECZEMA. 185 

Piper methysticum. — Skin dry, scaly, cracked and ulcer- 
ated, especially where it is thick, as on the hands and 
feet. 

Piper nigrum. — Eczema on the lips. 

Psorinum — Dry and scaly eruption, with little pointed 
vesicles around the reddened edges, disappearing during 
summer, but reappearing when the cold weather comes 
on; violent itching, worse by heat of bed and scratching; 
dirty, greasy-looking, foul-smelling skin. This remedy 
should be thought of in cases which do not yield to the 
well-selected remedy and compared with Sulphur. 

Ranuncuhis bulb. — Vesicular eruption on face in clus- 
ters, as from a burn; smarts as if scalded; aggravated in 
the evening, from change of temperature, from touch 
and motion. 

Rhus tox. — Eczema inner side of thighs, particularly 
after vaccination, with much itching and thirst; the erup- 
tion is generally moist, the surface raw, and the parts 
swollen; a red, inflamed, swollen rim from subcutaneous 
infiltration surrounds every portion of the eruption 
{Ars., black rim around the eruption); white, thick, 
moist crusts form, which smell offensively, and itch, 
especially at night; cheeks, face, and scalp affected; 
falling off of the hair; milk crust on face, humid, angry- 
looking, with hard, brown crusts; eczema of the scrotum, 
with intolerable itching. The child is restless, wants to 
be moved continually, especially after midnight, when 
the itching is intense, but this is relieved for a time by 
scratching; the cold fresh air is not tolerated on the 
head; it seems to make the scalp painful; hence the child 
likes to have its cap on in the open air (compare Silicea'). 

Rhus venenata. — Fine vesicular eruption on the upper 
extremities; groups of watery vesicles on the fingers; 
fissures on the ends of the fingers; upper lip swollen and 
covered with vesicles. 
13 



186 SKIN DISEASES. 

Sarsaparilla, — Eczema on the nose and face; thick 
scabs on the face; scabby eruption on the nose and face, 
like milk crust ; intolerable itching, worse at night, and 
after getting heated; child cries a great deal and is ex- 
tremely restless. 

Sepia. — Eruptions during pregnancy and nursing; 
itching of skin, changing to burning when scratched; 
sensation as of ants crawling over the skin; soreness of 
the skin and humid places in the bend of the joints and 
behind the ears; pruritus, with vesicles on a red base over 
all parts of the body. Dry ringworm, especially on the 
face of children; dry offensive eruption on the vertex and 
back of head, itching and tingling, with cracks behind 
the ears; pruritus, with vesicles on acrid base over all 
parts of the body, face, eyelids, hands, feet, armpits, 
vulva, anus, ears, hairy parts. Great indifference or 
sadness; wakes about 3 AM. and lies awake for hours; 
patient has dark hair, thin, delicate skin, brown discol- 
oration of the forehead, and passes putrid urine (compare 
Calc. OS., Benz. ac); aggravated in the open air, from 
application of cold water; ameliorated from warmth in 
general. 

Silicea. — Eczema capitis, with humid itching eruption 
in scrofulous children; pale, cachectic countenance; en- 
larged cervical glands; leucorrhoea, backache; menses 
too profuse; eruption on the back part of the head, either 
moist, or dry and scaly; offensive; scabby; itching during 
the day and evening, never at night; soreness after 
scratching; burns; pustules form and discharge copiously. 
Child cries when spoken to; big-bellied children, with 
weak ankles; emaciated frame, and irritable tempers, 
with perspiration about the head towards morning; 
offensive perspiration on the feet and genitals; aggra- 
vated during day and evening, and about the new moon; 
ameliorated from warmth in general. 



TREATMENT OF ECZEMA. - 187 

Staphysagria. — Eczema with yellow, moist, offensive 
scales, with considerable itching, disappearing after 
scratching, but soon returning; oozing after scratching; 
humid scabs with bad smell; j^ellow acrid moisture oozes 
from under the crusts; scratching sometimes changes the 
locality of the itching; scalp painfully sensitive; skin 
peels off with itching, hair falls out; itching of the mar- 
gins of the lids. Face sunken; nose pointed and blue 
rings encircle the eyes; the child is irritable, and in- 
dignantly throws things away from it which were desired 
but a moment before. Aggravated from scratching, from 
touching the affected parts, from abuse of mercury. 
Ameliorated from walking in the open air. 

Sulphur. — Sequela of a suppressed eruption; voluptu- 
ous itching, with soreness after scratching; eruption on 
back of head and behind the ears, around the margin of 
the hairy scalp from ear to ear posteriorly; dry, offen- 
sive, scabby, with cracks, easily bleeding, burning 
and painful; or humid, and offensive, discharging thick 
or thin acrid pus, which forms into yellow crusts; 
chronic cases; the child cannot bear to be washed; is 
most comfortable when dirty; morning diarrhoea, or 
bowels moved regularly, but always with great pain. 
Aggravated from getting warm in bed, from washing, 
from wet poultices; ameliorated from heat, in dry 
weather; after rising. 

Sulphuric acid. — Moist eczema after suppressed gonor- 
rhoea, with pricking of the skin; on scratching the itch- 
ing changes locality; aggravated in the open air. 

Sumbul. — Eczema on the left side of the scalp in infants. 

Terebinthina. — Infantile eczema in front of ear, tending 
to affect the eyelids {Graph., behind ear), often alternat- 
ing with otitis. 

Thuja. — Itching vesicles, with shooting pains; skin 



188 SKIN DISEASES. 

extremely sensitive to touch; burns violently after 
scratching; dry, scaly eruptions on head, extending to 
the temples, eyebrows, ears and neck, with itching, 
tingling and biting; dryness of covered parts; per- 
spiration of parts uncovered, smelling like honey; 
eruption only on covered parts; after vaccination 
the eczema is worse (SiL); eruption is white, scaly, 
and desquamating; offensive perspiration of the feet; 
wants head and face wrapped up warm (Stl.). Ag- 
gravated from cold, wet, heat of bed, about 3 a. m. ; 
ameliorated from gentle rubbing (itching); from warm 
wet (reverse, Lj'c. and Suipk.); from a development of 
coryza. 

Vaccinatio7i. — Several cases have been reported cured 
by vaccination; I have had no personal experience with 
this agent in this disease. 

Vinca minor. — Eczema on head, face, and septum of 
the nose; humid eruptions, itching at night, with burn- 
ing after scratching; offensive moist verminous eruption 
with biting itching; eruptions appearing in spots, 
moisture oozes therefrom and the hair becomes matted. 

Viola tricolor. — Eczema impetiginoides, exudation of 
yellow viscous pus; the eruption burns and itches, espe- 
cially at night; thick crusts form; swelling of cervical 
glands; urine smells like cat's urine; eczema capitis or 
facei, in scrofulous children. 



CHAPTER IX. 

BULLOUS DISEASES AND ANOMALOUS 
FORMS OF BULLOUS ERUPTION. 

Under this head we include the diseases which are 
especially characterized by the occurrence of the bullae as 
primary and essential phenomena. A bulla is a large 
portion of the cuticle detached from the skin by the inter- 
position of a transparent watery fluid. In fact, a bulla is 
a large vesicle. In the wide sense of the term several 
diseases are really bullous, such as erysipelas, herpes, 
pemphigus, rupia, eczema of the fingers, and impetigo 
contagiosa. But of these there are only two that really 
rank under the term bullous — i. e., herpes and pemphi- 
gus. Erysipelas belongs to the class of zymotic diseases; 
rupia is always syphilitic, and of course it is grouped un- 
der that head; the bulla produced by the coalescence of 
vesicles in eczema is an accidental and secondary phe- 
nomenon; and in impetigo contagiosa, the primary stage 
is a vesicle and not a bulla, the secretion subsequently 
becoming sero-purulent, whilst the general behavior and 
outward aspect of the disease are those of an impetigo. 
Besides, herpes and pemphigus are peculiar and like in 
regard to the influence of the nervous system in their 
production. Therefore, true bullous diseases, or those 
which are probably of neurotic origin, and in which the 
bullae are primary, with transparent contents, are herpes 
and pemphigus. 

Herpes and pemphigus might have been placed under 



190 SKIN DISEASES. 

the head of neurotic diseases, but then many others must 
have been included, such as urticaria, pityriasis rubra, 
etc., with them, if we carried out the idea of collecting 
together under one head all those diseases which pri- 
marily originate in disturbance of the nervous system 
and arranged them upon a pathological basis As we 
have classified diseases, however, clinically, we place 
herpes and pemphigus under the convenient but most 
unscientific term, "bullous inflammation," because it is 
to changes implied by that term that the practitioner first 
directs his attention in the matter of diagnosis and treat- 
ment. 

Some anomalous forms of eruption will be noticed at 
the latter part of this chapter. 

Herpes. 

The term herpes, used b}^ itself, has little significance, 
but the expressions herpes zoster, herpes labialis, herpes 
prog e7iita lis , etc., refer to definite and distinct affections. 
The first of these we will describe under the name of 
Zoster, but the other two will be considered here. 

Herpes Labialis. 

Herpes is an affection of the skin, characterized by the 
development of small clusters of vesicles, usually situated 
on a slightly reddened or inflamed surface, and in the 
immediate neighborhood of the mouth. 

The vesicles appear unattended with any pain other 
than a slight burning or itching sensation, and last for a 
few hours or a day or two. They then rupture and give 
exit to a slight serous discharge, when they dry up and 
leave a surface which heals in a short time without scars. 

Herpes labialis usually attacks children or women, but 
is not commonly met with in men. It frequently comes 



HERPES PROGENITALIS. 191 

on as a sequel of a cold, or slight febrile attack, and on 
this account has received the names " cold sore," " fever- 
sore," etc. 

There may be a single group of vesicles, or there may 
be several, each group containing four or five vesicles. 
The eruption may be confined to one side of the face, 
affecting either the upper or lower lip, or both, or just as 
frequently it may appear on both sides of the mouth. A 
true zoster ma}^ appear on the face and invade the same 
regions as herpes labialis, except that the eruption is 
almost invariably unilateral. 

The local treatment of herpes labialis involves nothing 
more than a little absorbent powder, or a sedative lotion — 
a little camphor- water being a favorite application. 

The internal treatment will be taken up in the next 
article. 

Herpes Progenitalis. 

The term hei-pes progenitalis includes the herpetic 
affections of the genital organs of both sexes, and, when 
occurring in the male, is called herpes preputialis , and in 
the female heypes vulvaris. 

Herpes preputialis most frequently occurs in young 
men between the ages of 20 and 40, and is not often met 
with as a first attack after that age. The vesicles may 
form on both the cutaneous and mucous surfaces. Owing 
to the anatomical situation of these parts, and to the 
friction to which they are more or less subject, the ves- 
icles last for but a few hours oxAy, breaking and giving 
rise to superficial erosions, which from neglect or un- 
cleanliness may run into slight ulceration. 

In herpes vulvaris the lesions may be upon the labia 
majora or the labia minora, or upon the prepuce of the 
clitoris, running the same temporary course as the other 
varieties of the affection. 



192 SKIN DISEASES. 

Herpes progenitalis is not usually accompanied with 
much pain, unless the parts are subjected to undue fric- 
tion. As in the male, herpes of the female organs is 
most frequently met with between the ages of 20 and 40. 
A single attack lasts for a few days only, but with many 
patients herpes proves to be a relapsing affection, and 
causing on this account serious inconvenience to those 
who are subject to it. In men, relapses may occur after 
almost every act of sexual intercourse, but curiously is 
much less frequent in married men than in those who 
indulge promiscuously and at irregular intervals only. 
In women of the town the affection is by no means un- 
common, but is very rarely met with in married women 
or virgins, except when the attacks coincide with men- 
strual periods. 

In this connection I will quote from an article in the 
Journal, Cutaneous and Veneral Diseases, August, 1883, 
where Dr. Unna reports his experience. He has met 
with 200 cases in the female. He says: "In France, 
where prostitution is under surveillance, and where ex- 
cellent syphilographers abound, herpes progenitalis early 
attracted attention and was ascribed to an unnatural irri- 
tation of the sexual organs to w^hich prostitutes are sub- 
ject. Venereal diseases cannot be the cause, for in mar- 
ried women suffering from syphilis or gonorrhoea herpes 
is not found. In prostitutes, herpes occurs as often in 
those without as those with syphilis. Acute and chronic 
blenorrhoea often exist as factors in the development of 
herpes progenitalis, by the congestion of the parts which 
they induce. There are prostitutes who have an attack 
of herpes every time they menstruate. Less frequently 
pregnancy and the puerperal state induce a disposition to 
herpes progenitalis. Bruneau must be given credit for 
having shown that in women suffering with chronic 



HERPES PROGENITALIS. 193 

metritis, cervicitis, etc., every herpetic eruption is pre- 
ceded by increased sensibility and signs of heightened 
congestion of the pelvic organs. While the vesicles are 
still intact, the diagnosis is easy. The vesicles are yel- 
lowish, translucent and arranged in clusters. When 
the epidermis has given way, the surface crusted over, 
erosion present, the surface must often be first carefully 
cleansed before we can say whether the disease be a 
superficial wound, a burn, eczema, chancre or herpes. 
Herpetic erosions are all well defined and of a bright red- 
dish hue. They are discrete, coalescent or confluent. In 
any case, the sharply defined contour and crescentic ar- 
rangement make herpes easy of diagnosis. The parts 
most liable to this affection, in order, are the labia 
minora, prepuce of the clitoris, labia majora, introitus 
vagina, and caruncula myrtiformis. The disease may be 
unsymmetrical when such organs as the prepuce of the 
clitoris, perineum, etc., are attacked. Pain usually pre- 
cedes the eruption by several days." 

The etiology of herpes progenitalis is obscure, and no 
adequate- explanation has yet been given to account for 
the attacks. 

Diagnosis. — The diagnosis of herpes progenitalis 
presents little difficulty, but care should be taken to dis- 
tinguish it from mechanical abrasions and from conta- 
gious venereal lesions. 

The treatment of this affection is simple. As a rule, 
nothing more is required than a little dressing-powder, 
or a sedative lotion; and if the parts are left at rest the 
erosions will be covered with new epithelium in a few 
days. Should ulcerations have occurred, they may be 
lightly touched with the solid nitrate of silver, and small 
pieces of linen may be placed between folds of mucous 
membrane that are lying in contact. These should be 



194 SKIN DISEASES. 

frequently changed , and the parts kept clean with warm 
water and soap. 

When the affection assumes the relapsing form, pa- 
tients will go from one physician to another, seeking a 
permanent cure, which we regret to say they will rarely 
attain until they reach the age at which the trouble tends 
to disappear spontaneously. 

The internal treatment and the indications for the 
remedies are as follows: 

Acojiite. — In the earlier stages with catarrhal fever. 

Agnus castus. — Herpes on the cheeks with gnawing 
itching, worse from getting wet. 

Alnus rubra. — Chronic herpes. 

Apis mel. — Large confluent vesicles; burning stinging 
pains; vesicular eruption on the lips; cold sores. 

Arsen. alb. — Red herpetic skin around the mouth, with 
burning, worse from scratching and after midnight. 
Herpes iris. 

Aurum rnur. — Herpes on the prepuce and vulva. 
Herpes accompanied by intolerable itching. 

Bufo. — Herpetic eruption after a cold. 

Causticuni. — Burning vesicles under the prepuce, which 
become suppurating ulcers. Burning vesicles on the face 
which, when touched, exude a corrosive water, afterward 
they dry up to a scurf. 

Cantharis. — Large, burning painful blisters with ery- 
sipelatous inflammation of the parts. Burning, tearing 
ulcerative pains, worse on the right side. Urinary com- 
plications. 

Clematis. — Itching blisters on the lower lip. Gnawing 
itching not relieved by scratching. Worse during in- 
creasing, better during decreasing moon. 

Graphites, — Herpes in females with scanty menstrua- 
tion; burning blisters on the lower side and tip of the 
tongue; dryness of the skin. 



HERPES PROGENITALIS. 195 

Hama7nelis — Herpes on the nose. Profuse epistaxis. 

Helleb. nig. — White vesicles on the lips; aphthae in the 
mouth; in scrofulous children. 

Hepar. — Herpes which tend to recur; herpes on the 
prepuce, exceedingly sensitive to the touch; small ulcers 
form around the large one; unhealthy suppurating skin, 
after mercurial poisoning. 

Kali bich. — Herpes after taking cold; fluent coryza; 
all the secretions are of a stringy and ropy character. 

Merciirius sol. — Herpes on the prepuce with a tendency 
to suppuration; ulcers on the glans; itching of the 
genitals. 

Moschus. — Herpes, with excessive burning, in hyster- 
ical subjects; menstruation too early and too profuse. 

Natrum mur. — Herpes occurring during fevers; erup- 
tion on the lips and flexures of the joints; vesicles on the 
tongue; itching and pricking in the skin. 

Petroleum. — Herpes on the perineum and genitals; 
itching worse in the open air. 

Rhus tox. — Herpes upon the hairy parts with burning 
and stinging; itching worse after scratching; rheumatic 
pains with great weariness. 

Sepia. — Herpetic eruptions around the lips; herpes 
during pregnane}^- circular form of epilepsy. 

Sulphur. — Herpes about the mouth and nose with 
itching and burning, aggravated by warmth. Hot palms 
and soles. 

Sarsaparilla. — Herpes on the prepuce; after abuse of 
mercury. 

Upas. — Herpetic eruption on the upper lip, on the 
left side. 



196 SKIN DISEASES. 

Zoster. 

Zoster is an acute affection characterized by the devel- 
opment of one or more groups of large-sized vesicles. 
When there are several of these groups, it will be noticed 
that they are arranged along the course of one of the 
larger nerve-trunks whose filaments are distributed to the 
skin. 

The most frequent and perhaps the most typical seat of 
the eruption is on the chest, where it may form a semi- 
girdle corresponding to the area supplied by one of the 
intercostal nerves. Zoster, however, is by no means con- 
fined to the thoracic region, but may appear on the ab- 
domen, the face, in connection with the trigeminal nerve, 
on the shoulders and arms, and on the thighs and legs. 

The eruption may or may not be preceded by prodro- 
mal symptoms, which may partake of a mild febrile 
attack of one or two days' duration, or, instead, of a 
more or less, severe neuralgia, without fever; or neither 
of these phenomena may be present, the eruption itself 
being the first indication of the affection. 

Each group or patch of vesicles may consist of from four 
or five to a dozen separate, non-confluent lesions situated 
upon a reddened, raised, and inflamed base. Occasionally 
the vesicles themselves may be absent, and nothing is to 
be seen except the circumscribed reddened patch. The 
several groups of vesicles constituting the typical erup- 
tion do not usually appear at the same time, but the 
patches may appear in succession, so that several days 
may elapse before all the lesions have developed. 

The eruption having appeared, is accompanied with 
more or less pain of a neuralgic character, together with 
some soreness of parts if the vesicles rupture. As a rule, 
the lesions remain intact until after a week or so, when 



M-^^ 



I 



Zoster. 



ZOSTER. 197 

the fluid contents become absorbed, and the upUfted 
epidermis desquamates, leaving a reddened macule, or in 
some cases a small cicatrix, to mark the site of the lesion. 

A striking peculiarity of zoster is the fact that it is 
strictly unilateral (with exceedingly rare exceptions). 
Cases of double zoster, in which both sides of the body 
have been involved at the same time, have been reported. 
Another feature of this affection is the extreme rarity of 
a second attack, resembling in this respect the eruptive 
fevers. 

The neuralgia which precedes or accompanies zoster 
may exhibit any degree of severity, and may indeed per- 
sist for an indefinite period after all symptoms of cuta- 
neous irritation have disappeared. Instead of neuralgia, 
a more or less intense pruritus ma}^ be present, confined 
to the affected region, and persist for a long time. 

As a rule, zoster is an affection of little gravity — that 
is, in persons who when attacked are in ordinary health. 
In those, however, who are aged or feeble, the prog- 
nosis is not always so favorable, as the vesicles may be 
followed by more or less severe ulceration. When the 
eruption appears on the head, and especially in connec- 
tion with the branches of the trigeminus that are dis- 
tributed to the eye, ulceration of the cornea, and even 
destruction of the sight, may ensue. 

Etiology. — It has been very clearly demonstrated that 
the majority, if not all cases, of zoster appear in connec- 
tion with irritation or inflammation of the ganglia at- 
tached to the roots of the sensitive nerves; but what sets 
up this primary irritation is not always clear. Zoster has 
been known to appear, after exposure to cold, in connec- 
tion with pleurisy, after traumatisms, and after the 
internal administration of arsenic. Quite recently, 
bacilli are said to have been found in the inflamed 



198 SKIN DISEASES. 

ganglia, but how they got there does not appear very 
clearly. 

M. Fere reports four cases of herpes zoster, which oc- 
curred nearly contemporaneously among his 150 epileptic 
patients at the Bicetre. The first was a young man of 
nineteen, who had had a few violent epileptic attacks 
without any unilateral symptoms. The herpes was con- 
fined to the left side of the thorax and the left side of the 
face, and along with it he had some spasms of the left 
corner of the mouth, illusory impressions of persons ap- 
proaching him from the left side, and some contractions 
and sluggishness of the left pupil. The left side of the 
tongue also was much more thickly furred than the right. 
The temperature ran up to 107° F. at first, but all the 
morbid symptoms gradually subsided in a week. In the 
three other cases, in middle-aged men, the most promi- 
nent symptom was severe pain, with tenderness on pres- 
sure, down the spinal column. M. Fere is led to con- 
clude from these and similar observations that the most 
probable cause of the herpetic eruption is a slight 
epidemic cerebro-spinal meningitis, which may be 
widespread, but perhaps only of sufiicient irritative 
power to cause the herpes at the root of one or two 
nerves. Such a pathological condition would not be 
surprising in infectious diseases, for in them some forms 
of meningitis are not rare. 

Zoster may follow influenza; Dr. Finzi reports a case 
in a girl of fifteen, who, after recovering from a 
severe attack of influenza, was seized with neuralgic 
pain, accompanied with a pricking and burning sensation 
shooting from the back around the right side. On being 
seen five days later, a chain of herpetic vesicles was 
found extending along the seventh intercostal space, the 
lymphatic glands in the axilla being swollen and tender, 



ZOSTER. 199 

and pressure along the course of the seventh intercostal 
nerve, making the patient scream with pain. In from 
eight to ten days the vesicles disappeared, the whole 
duration of the S3"mptoms having been about a fortnight. 

Another case is reported of a case of zoster correspond- 
ing to the eighth intercostal nerve of the right side in a 
girl of eighteen, in whom the disease appeared at the be- 
ginning of an attack of influenza and lasted a month. 

The writer had a case occurring in a girl of twelve cor- 
responding to the eighth intercostal nerve of the left side, 
in which the eruption made its appearance three days 
after the beginning of an attack of influenza of a severe 
form, and the eruption lasted two weeks. 

Treatment. — The chief indications are to preserve the 
integrity of the vesicles until their contents are absorbed, 
and to give relief to the neuralgic pain. We may at- 
tempt to carry out the first by the application of several 
coats of flexible collodion, or trauviaticin, or we may 
brush the lesions over with oil, and then cover them 
freely with some indifferent dusting-powder. The neu- 
ralgia is to be treated exactly in the same way as if it 
were not accompanied with the vesicular lesions. 

Zoster of the mucous membranes is not an infrequent 
affection. Three cases are reported in which the region 
supplied by the trigeminus was affected. In one of 
the cases the vesicles were located upon the mucous 
membrane of the left cheek; in the second case upon the 
conjunctiva of the right eye; and in the third case on the 
left half of the tongue. 

The galvanic current, from four to eight cells of a bat- 
tery of ordinary strength, has been found very beneficial 
if the pain is sharp, w^hen applied from fifteen to twenty 
minutes daily. 



200 SKIN DISEASES. 

The principal internal remedies and their indications 
are as follows: 

Aconite. — In the earlier stages, when the neuralgic 
pain is accompanied by febrile symptoms. 

Apis. — Burning and stinging pains with swelling; large 
vesicles, sometimes confluent; better from cold applica- 
tions. 

Arsen. alb. — Confluent eruption with intense burning 
of the blisters; worse after midnight, and from cold ap- 
plications; neuralgia; in debilitated constitutions. 

Cantharis. — Large blisters, burning when touched; 
smarting and stinging; mostly on the right side; worse in 
the open air. 

Cistus. — Zoster on the back; neuralgic symptoms; in 
scrofulous subjects. 

Comodadia. — Zoster on the legs; rheumatic pains ag- 
gravated by rest; relieved by motion. 

Dulcamara. —Zoster after taking cold from damp air; 
moist, suppurating eruption; glandular swellings in 
neighborhood of eruption; eruption precedes the menses. 

G7'aphites. — Zoster on the left side; large blisters from 
the spine to the umbilicus, burning when touched; worse 
indoors; better in the open air; dry skin, tendency to 
ulceration; in blonde individuals inclined to obesity. 

Iris vers. — Zoster, especially on the right side; follow- 
ing gastric derangement; pain in the liver; neuralgic 
pains. 

Kali mur. — Zoster; vesicles encircling half of the body 
like a belt; white tongue. 

Kalmia lat. — Facial neuralgia remaining after zoster; 
worse at night; palpitation of the heart ; rheumatic pains. 

Lachesis. — Zoster during spring and fall; the vesicles 
turn dark and are very painful; all symptoms are worse 
after sleep. 



ZOSTER. 201 

Mercurius. — Zoster on the right side, extending across 
the abdomen; worse at night, from the warmth of the 
bed; tendency to suppuration; easy perspiration without 
relief. 

Mezereum. — Zoster in old people; constant chilliness; 
neuralgic pains; worse at 9 p. m.; burning, changing lo- 
cation after scratching; in scrofulous persons. 

Natrum mur. — Eruptions occurring through the course 
of any disease. 

Pepperini7it Oil, when applied locally, rapidly allays 
the pain of zoster. 

Pru7i2is spinosa has succeeded in removing the very 
troublesome neuralgic pain which often remains when 
the eruption of shingles has disappeared, by means of 
Prunus spinosa 30X. 

Ranunculus bulb. — Zoster aggravated by change of 
temperature; neuralgic sequels; in rheumatic subjects. 

Rhus lox. — Burning and stinging pains aggravated by 
scratching. Small burning vesicles with redness of the 
skin; confluent vesicles; worse in cold weather; rheu- 
matic pains during rest; sleeplessness with restless toss- 
ing about; zoster brought on by getting wet, while over- 
heated. 

Seinpervivum ted. — In obstinate cases; may be used 
internally and locally. 

Thuja. — Zoster with eruption only on covered parts; 
better from gentle rubbing; in individuals of lymphatic 
temperament. 

Zincum. — Neuralgia following zoster; pains relieved by 
touching the parts; worse after dinner and towards 
evening. 

'Zincum phos. — When other remedies fail; following 
brain-fag in literary persons. 



14 



202 SKIN DISEAvSES. 



Pemphigus. 

Under this name a number of widely varying diseases 
have been described, and one of the earlier writers men- 
tions upward of a hundred varieties of the affection. 
We will confine the name to a single disease, embracing- 
but two varieties — namely, pe^nphigtcs vulgaris and pem- 
phigus foliaceus . 

In childhood two forms are observed; pemphigus acutus 
neo7iatorum, appearing during the first two weeks. The 
whole body is covered with bullae, some of the size of a 
hazel nut, and its course usually benign. A second form 
stands in close relationship to acute exanthemata. 

In general pe77iphigus is characterized as regards erup- 
tion by the appearance of little separate blebs, usually 
grouped in threes or fours, seated upon slightly inflamed 
bases, which are quickly covered over by the enlarged 
bullae. These blebs ma}^ attain a size varying between 
that of a pea and a hen's ^z%. They are distended with 
fluid, which is at first very transparent, but soon becomes 
milky. The fluid may be quickly re-absorbed, or the 
blebs or bullae simply shrivel, the distended globe becom- 
ing flaccid. Very often the blebs burst in a few days, 
and then the contained fluid dries into crusts of lamellar 
aspect, beneath which is very slight ulceration. The 
contents are sometimes sanguinolent. The bullae gener- 
ally occur in successive crops; they develop in the course 
of a few hours; their outline is generally round or oval; 
they may be confluent, but are usually distinct. Now 
and then a species of false membrane is contained in the 
bullae. The reaction of the fluid is generally alkaline, 
but with the turbidity comes acidity. The local symptoms 
are, slight itching and smarting at the outset, and more 



PEMPHIGUS VULGARIS. 203 

or less soreness. The healing process in pemphigus is 
sometimes tard}^, a thin ichor being secreted by the sur- 
face originally blebbed, and so a quasi-impetiginous crust 
is often produced. In rare cases, in cachectic subjects, 
sloughing may occur. The disease attacks all parts of 
the body — but rarely the head, the palms of the hands, 
or the soles of the feet. Sometimes the mucous surfaces — 
for example, the intestines, vagina, etc., are the seat of 
bullae in pemphigus. 

Pemphigus Vulgaris. 

This variety is characterized by an eruption of bullae 
of varying size, some of which may be as large as a 
pigeon's egg. They may exist singly or in considerable 
number, and successive outbreaks may prolong the affec- 
tion for an indefinite period. 

In pemphigus vulgaris the bullae are well distended 
with a thin, not ver}^ plastic fluid, and usuallj- remain in- 
tact for several days. Sometimes the fluid is resorbed, 
and the uplifted epidermis applies itself to the skin, with- 
out, however, becoming permanentl}^ attached, but ex- 
foliates as soon as a new stratum corneum has formed 
beneath it. 

More frequently, however, the bulla ruptures and be- 
comes detached, leaving a raw and reddened surface, 
giving rise to a slight serous discharge. This gradually 
lessens, however, until a newly-formed, horny laj^er re- 
places the old. 

Solitar3^ bullae ma)^ succeed each other at more or less 
regular intervals, or there may be crops of smaller bullae, 
appearing weeks or months apart. 

The disease may persist unchecked for several years, 
terminating in spontaneous recovery, or quite frequently 
ending fatally. 



204 SKIN DISEASES. 



Pemphigus Foliaceus. 

In this variety the bullae, instead of being freely dis- 
tended and tense, are only partly filled with fluid, and are 
flaccid, and often attain a considerable size. As a rule, 
they are accompanied with more or less debility and im- 
pairment of the vital forces. Contiguous bullae may 
coalesce, thus forming a large, flat, watery tumor, con- 
taining a lymphy exudation. The prognosis of pemphi- 
gus foliaceus is grave, as the majority of cases go on to a 
fatal termination. 

In some instances pemphigus foliaceus is said to begin 
as a single blister, which continually enlarges until the 
whole surface of the body is skinned and covered with 
a brownish crust; it is always fatal. 

The causes of pemphigus are involved in obscurity. 

Prognosis. — The cure is not rapid, but slow; recur- 
rence of the disease is frequent. In old people, where 
the disease is general, and in children, when there is. 
ulceration, the issue of the case is often unfavorable. The 
general condition of the patient must be the guide, and 
in these cases a cautious opinion should always be given. 

Diagnosis. — Pemphigus can scarcely be confounded 
with anything else, the bullae are so diagnostic a sign. 
In eczema of the hands, bullae may be produced second- 
arily by the confluence of vesicles, but their origin is 
readily traced, and co-existent eczema is to be found 
elsewhere. Pemphigus is rare on the hands and fingers, 
per se. General eczema and P. foliaceus should not be 
confounded; in the latter abortive bullae are present, the 
scales are larger and peculiar, and the skin is not infil- 
trated. 



PEMPHIGUS FOLIACEUS. 205 

In ecth3^ma cachecticiim the pustules contain bloody 
fluid; there are no true bullae in the disease; the crusts 
are also thick and dirty; whilst the ulceration is deep. 
In rupia, the bullae are smaller and flatter, the contents 
sanious, the crusts thick, dark, prominent — cockleshell 
like; the ulceration deep and foul. Pemphigus foliaceus 
resembles pityriasis rubra; but in the latter there is no 
history of bullae; the scales are altogether smaller, and 
they are imbricated in a peculiar manner. 

Sometimes in impetigo contagiosa, the bullae become 
somewhat large, but they are never distended as in pem- 
phigus, but flat; the contents soon become purulent, and 
flat yellow scabs form, which are characteristic. The 
disease is clearly pustular. 

Treatment. — The patient should be placed on a full 
animal diet, with plenty of fresh air and exercise. Means 
must be taken to bring the health up to a normal 
standard. 

Locally, bran, starch or gelatine baths are of decided 
benefit. The continuous bath, as recommended by 
Hebra.may be resorted to in some cases. 

The old school rely upon quinine, the mineral acids, 
and arsenic, as internal remedies. They recommend 
cod-liver oil, combined with either of the above, it is a 
favorite prescription with many. 

Dr. Cooper has cured pemphigoid eruptions, particu- 
larly those occurring in the ears, with an ointment of 
scrophulaida nodosa. The same medicine was very useful 
in bullae surrounded by an inflamed ring. 

Dr. Pope ameliorated a distinctly pemphigoid eruption 
with Cantharis 3X. Later in the case — one of dissemi- 
nated sclerosis — the eruption reappeared, and passed 
away without rupture under Phosphorus given on gen- 
eral indications for that drug. 



206 SKIN DISEASES. 

The indications for the principal internal homoeopathic 
remedies are as follows: 

Ammo7i. miir. — Blisters the size of peas on the right 
shoulder with itching; burning at small spots on the 
chest; chilliness, especially when walking; fat body but 
thin legs. 

Arsen. alb. — Black blisters, burning and very painful; 
great restlessness and typhoid symptoms; pemphigus 
foliaceus or when gangrene sets in. 

Belladon. — Painful, watery vesicles on the palm of the 
hand sensitive to the touch; chill in the evening, mostly 
on the arms, with heat in the head. 

Ca7itharis. — Pemphigus presents a very exact image of 
the lesion produced by the external application of can- 
tharides; active inflammation, with blisters containing 
serum, burning more than itching; more on right side. 

Causticum. — I^arge painful blisters on the left side of 
the chest and neck, which become flattened; with the 
eruption, there is difficulty of breathing, fever, heat and 
sweat; very sensitive to cold; corpulent children, with 
tendency to enlargement of glands; involuntary urination 
when sneezing or blowing the nose. 

Chamo?nilla. — Extreme irritability of the nervous sys- 
tem and great sensitiveness to pain, or to wind or cur- 
rents of air; darting and lancinating pains. 

China. — Great nervous irritability; the contents of the 
vesicles becomes ichorous with a putrid smell; where 
there is a tendency to gangrene. 

Clematis. — Burning throbbing pains; yellow corrosive 
ichor; great emaciation. 

Didcajnara. — Burning pains, restlessness, thirst and 
emaciation; the bullse break forming corroding ulcers, 

Gumnii gutti. — May be used when other remedies fail. 



PEMPHIGUS FOLIACEUS. 207 

Kali carb. — Burning, itching and stitch pains; blisters 
with tendency to spread; pemphigus foliaceus. 

Iodine. — Gangrenous tendency, after mercury. 

Lachesis. — Gangrenous tendency; bullae and blisters; 
tossing and moaning during sleep, and aggravation of 
symptoms on awaking. 

Me7ruri2is. — The bullae have a tendenc}^ to spread, 
with discharge of burning ichor, worse at night, particu- 
larly from warmth of the bed; profuse sweat which does 
not relieve. 

Natrumcarb. — BHsters with oozing of purulent fluid; 
the whole skin becomes dry, rough and chapped. 

Natrum mur. — Fluid from blisters and blebs like water. 

Natrum siilph. — Watery vesicles or blebs all over the 
body. 

Phospho7dc acid. — Deep hard bullae on the ball of the 
thumb; blisters on the balls of the toes; great drowsiness 
and apathy; in debilitated individuals; after sexual ex- 
cesses. 

Phosphorus. — The blisters are full to bursting, painful 
and hard, but not itching; tall fair children with tendency 
to tuberculosis; languor and nervous itching; chilliness 
-every evening with shivering; arms and hands become 
numb; regurgitation of food; small wounds bleed much. 

Ranmiculus bulb. — Blisters on the fingers the size of a 
hazelnut, followed after healing by small deep transparent 
dark-blue elevated blisters the size of ordinary pin-heads; 
this remedy has cured pemphigus in new-born children. 

Ranunculus seel. — Vesicles, which emit a thin acrid, 
3^ellowish ichor, and form obstinate ulcers; itching, boring, 
gnawing and biting pains; sleeplessness, with debility 
and anxiety. 

Raphanus. — Blisters full of water on the breast, with- 
out inflammation, redness or pain. 



208 SKIN DISEASES. 

Rhus tox. — Acute form, with much itching and burn- 
ing; confluent blisters with milky or watery fluid and 
peeling of the skin. 

Sepia. — Pemphigus on the arms and hands; heaviness 
of the limbs; sensitive to cold air; arthritic pains in the 
joints. 

Tartar emet. — Vesicles filled with bloody serum, col- 
lapsing and bursting, turning blackish and changing ta 
malignant broad deep ulcers; gastro-intestinal irritation. 

Thuja. — Pemphigus foliaceus, with offensive odor, and 
formation of scales. 

Anomalous Forms of Bullous Eruption. Hydroa. 

Under the head of neurotic diseases, and in connection 
with herpes, attention may be directed to certain vesicu- 
lar or bullous forms of eruption, which have been de- 
scribed by Bazin under the term of arthritic hydroa. He 
distinguishes three varieties of hydroa: i. Hydroa vesi- 
culeux. 2. Hydroa vseciniforme, confounded with 
aphthae chronique. 3. H5^droa bulleux. 

Hydroa vesiculeux is generally confounded by authors 
with erythema papulatum. First, as regards Seat, "It 
is developed on the cutaneous and mucous surfaces. On 
the skin it exists ordinarily on the uncovered parts — 
back of the hands and wrists and on the front of the 
knees, etc In most cases the buccal mucous membrane 
is affected, and then the eruption occupies by preference 
the lower lip and the inside of the cheeks, and appears 
after its development on the skin. However, in one of 
our cases, the base of the uvula was surrounded by a cir- 
cle of vesicles. The conjunctiva may also be the seat of 
this eruption." 

Symptoms. — " It is sometimes preceded by malaise^ 



FORMS OF BULLOUS ERUPTION. 209 

anorexia, and a slight febrile attack, but these prodromic 
symptoms are often wanting, or are so little marked that 
the attention of the patient is first attracted by the de- 
velopment of the vesicles. 

Whatever be the seat of the eruption, it presents the 
following characters: — 

There is seen at first spots of a deep red color, small, 
rounded, a little raised, and with their edges clearl}^ de- 
fined. These spots vary in size from that of a lentil to 
that of a twenty-five cent piece; they are sometimes sur- 
rounded by a rose-colored areola; the}^ show soon in their 
centre a small vesicle filled with transparent yellowish 
liquid. This vesicle appears the day following that of 
the red spot. It dries rapidly from the centre, which is 
occupied by a small blackish scab, whilst the liquid is 
absorbed from the circumference. The phenomena takes 
place towards the second or third da}' of the eruption. 

The subsequent phenomena are as follows: — The liquid 
in the circumference of the vesicle is reabsorbed, whilst 
that which occupies the centre becomes a blackish scab. 
At last it may happen, especially during cold weather, 
that the fluid exuded in tbe vesicle is absorbed rapidl3^ 
It will then have only a small whitish or yellowish 
macula, placed in the centre of a red disc, and formed 
by loosened epiaermis. In this case it is that the affec- 
tion has been confounded with erythema papulatum. On 
the mucous surfaces the vesicles are whitish and sur- 
rounded by a violet-colored areola — the scabs are detached 
sooner. The red discs and vesicles are more or less 
numerous. The}' are generally separated by intervals of 
sound skin; sometimes they are disposed in groups of 
two or three, touching at their circumference. They do 
not all appear at once, but b}^ successive crops during 
many days. The affected parts have scarcely any itch- 



210 SKIN DISEASES. 

ing. The febrile symptoms which exist rarely at the 
commencement cease when the eruption is developed. 

The duration of hydroa vesiculeux is from two to four 
weeks; each element in the eruption taken by itself runs 
through its course in four or five days. The affection is 
prolonged for many weeks only by the eruption of fresh 
crops of vesicles. A relapse may take place. 

The disease is seen in both sexes, but more frequently 
in the male. It appears among adults from twenty to 
thirty years of age. It is more frequent in spring and 
autumn; cold and variation of temperature have a marked 
influence on its appearance and course. Finally it is 
always seen amongst people who have had still' symp- 
toms of gout." 

''Hydroa vesiculeux," says Bazin, in continuing his 
description, which we have given above almost at length, 
" is essentially arthritic — at least we have always found 
it among arthritic subjects, and it has steadily presented 
clear relation to gouty manifestations." 

Prognosis. — "This affection is not grave; it disap- 
pears of itself in four or five weeks. It is subject to 
recur." 

Hydroa vacciforme is the same, only that the vesicles are 
varioliform. 

Hydroa bulleux (pemphigus with little bullae) is an 
arthritic affection which is generally little known. 

The eruption shows itself by bullae, which present one 
important character — the inequality of their size. Some 
are as large as a lentil; the largest do not go beyond the 
size of a pea. These bullae are rounded, arranged in an 
irregular manner, in groups of three or four; they are 
filled with transparent fluid, which grows thick quickly 
and takes a yellowish color; finally they are placed on a 
red surface, which extends from their base in the form 



FORMS OF BULLOUS ERUPTION. 211 

of an areola. Whilst new bullae are developing, the 
old ones dry up and are replaced by a 3^ellowish scab; 
and if one of these is rubbed off by scratching there ap- 
pears a violet-colored, slightly excoriated surface In the 
interval of the crops of bullae there is no morbid phe- 
nomenon observed except the ordinary well-marked itch- 
ing. The patient preserves his appetite, and the nutrition 
is not at all altered. Bazin states that the course is 
chronic, that the disease appears in successive crops, and 
lasts generally from five to six months; that it is more 
frequent in men than in women, and appears in adults 
from twenty to forty years; that the seasons and varia- 
tions of temperature have a marked influence on its de- 
velopment; that it is most common in the spring, and is 
excited by gout. 

Diagnosis. — The characters of hydroa bulleux permit 
always of its being recognized. It is important to es- 
tablish well the differential diagnosis between this disease 
and pemphigus. In the former the bullae are small, and 
do not go beyond the size of a pea; they are further re- 
markable, for the inequality of their size, they occupy re- 
gions sufficiently well circumscribed. The bullae of pem- 
phigus are larger — they may attain the size of a nut, or 
even of a hen's ^gg; they exist in various parts, and ex- 
tend sometimes over the chief part of the skin. 

The diseases which it in a measure resembles are, ur- 
ticaria and the various forms of erythema, and perhaps 
mistakes might be made between it and the vesicular 
syphilide, varicella, and variola. As a rule, it has a defi- 
nite duration, and disappears spontaneously in a few 
days, and may be accompanied by slight fever. The first 
phenotnenon noticed is a faintly-marked, rosy spot, which is 
soon replaced by a single vesicle, which 7nay reniai7i intact 
or may become umbilicated, or may dry up and become a7i 



212 SKIN DISEASES. 

umbilicated crust of a yellowish- white color. Around this 
vesicle i?iflammatory changes very soon take place; a zone of 
a color varying from red to violet^ with a well-defined, 
slightly elevated periphery, forms, and then around this 
perhaps a ring of small vesicles, which may coalesce and 
form a circumferential bullce. These spots vary in size 
from a line to four or five, or even more. There is no 
hypersemia between the patches, as the inflammatory ac- 
tion is sharply confined to them. This condition differs 
from that of herpes phlyctenodes, in which the inflamma- 
tory areola is not thus sharply defined. There is usually 
no pain or itching, merely a little heat or a feeling of ten- 
sion. The same appearances, somewhat modified, have 
been observed upon the buccal mucous membrane. The 
eruption disappears by the fall of the crust, which is formed 
from the vesicle, and is generally seen in the centre of 
each patch, and then there remains a more or less well- 
marked hypersemia with slight infiltration. The sites of 
election are the back of the hands, the forearms, face, neck, 
and also the trunk and lower limbs. It is generally 
symmetrically developed. 

The practitioner may meet with cases in which, with or 
without some slight antecedents, malaise, or pyrexia, a 
few scattered spots answering as regards eruptive features 
to Bazin's hydroa vesiculeux occur — that is to say, a few 
red irritable spots appear, having in the centre a small 
oval or roundish bulla, which may enlarge to the size of a 
split pea, but is generally not so large, and dies away in 
the course of a few days. These spots appear on the 
back of the hands, the arms, the legs, and the shoulders. 
The disease may last, by the development of successive 
crops of solitary vesicles, for ten days or more. 

The more exaggerated form of this disease is that in 
which small bullae are developed rapidly over a large ex- 
tent of surface, or even the whole body. 



FORMS OF BULLOUS ERUPTION. 213 

In some instances in which this quasi-herpetic or pem- 
phigoid disease makes its appearance the eruption is pre- 
ceded by an unusual amount of irritation, and it is com- 
plicated or followed by true pruriginous rash. This is 
very probably the disease termed pemphigus pruriginosus. 

We may therefore sum up the foregoing remarks by 
saying that there is a form of disease which seems to stand 
midwa}^ between herpes and pemphigus, the features of 
which allay it, now to herpes, now to pemphigus. It may 
consist of solitary small bullae seated on a red base, and 
scattered here and there over the body, or the bullae may 
be surrounded by small vesicles; or these two dispositions 
of the bullae may be seen in one and the same case, the 
eruption being localized to a certain part of the body, or 
generally distributed and accompanied in severe cases by 
pyrexia and marked constitutional disturbances, which is 
often the result probably of malarial poisoning. The erup- 
tion may recur more or less periodically; and lastly it may 
be complicated or followed by prurigo, and in that case 
will answer to the designation of pemphigus pruriginosus. 

Diagnosis. — The characters I have given are sufficient 
for diagnostic purposes. The only disease with which 
they might be confounded is urticaria bullosa, and I do 
not know that any mischief would accrue to the patient 
from such a mistake. 

Treatment. — The first care of the ph3^sician is to at- 
tend to the general condition of the patients as regards 
their emunctory organs and their hygiene. Anxiety, 
worry, and depressing influences must be neutralized. 
The patient must be ordered to get good air, to take plain 
nourishing food, and to avoid luxuries of the table, over- 
work, and fatigue of all kinds 

Locally I know of nothing better than, first of all, va- 
por baths to encourage the skin to proper action, and the 



214 SKIN DISEASES. 

use of a weak lotion made of liq. carbonis detergens 3jj 
to ^ss with aquae |vj applied night and morning. Subse- 
quently sulphuret of potassium baths may be regularly 
given for a long time, and followed up by the drinking of 
some sulphurous or iron waters. 

According to old-school authorities, the main remedy 
is quinine; iron, nux vomica and cod-liver oil are also re- 
commended. 

The principal internal homoeopathic remedies are: Po- 
tassium iodide, Kreasote, and Mag?iesia carb. 



CHAPTER X. 

SUPPURATIVE INFLAMMATION, OR PUS- 
TULAR DISEASES— IMPETIGO— CONTA- 
GIOUS IMPETIGO— ECTHYMA— FUR- 
UNCULUS— ANTHRAX, OR CAR- 
BUNCLE—MALIGNANT 
PUSTULE, Etc. 

General Remarks. 

In many very different diseases of the skin pus is pres- 
ent, and if the term pustular were used in its widest 
sense a large number of diseases would have to be in- 
cluded under it; for instance, acne; favus; scabies; pem- 
phigus; variola; farcy; varicella; and so on. But in the 
diseases just named the presence of pus is often not a pri- 
mary or even essential condition, and its importance is 
thrown into the shade by the prominence of other feat- 
ures. In those affections which may more strictly be 
called pustular, the suppuration is the leading and the 
primary condition, the particular morbid condition the 
practitioner has to recognize and to remedy. Now un- 
der the term pustular diseases, thus defined, are usually 
comprised impetigo, ecthyma, and furuncular affections, 
— the latter term including furunculus, or boil; anthrax 
or carbuncle; and pustular maligna, or malignant boil. 
Delhi boil would come under this division, but, owing to 
its rarity in this country, will not be treated of. 



216 SKIN DISEASES. 



Impetigo Contagiosa. 

This disease is characterized by the appearance of 
mild pyrexial symptoms, followed in two or three days 
by the appearance of one or more small vesicles. They 
slowly enlarge, but soon dry into thin, light-yellow 
crusts, or scabs. These lesions may be few or numerous, 
and succeSvSive outbreaks may prolong the affection for 
several months. The affection is unquestionably conta- 
gious, and, when it once appears upon an individual, 
other members of the family, either children or adults, 
may contract it. In not a few instances the eruption has 
appeared within a couple of weeks or so after vaccination. 
If the crust, which has the appearance of being " stuck 
on," is removed, a slightly reddened but not eroded sur- 
face is revealed, from which but little or no moisture is 
exuded. 

The disease is seen amongst children of the lower 
orders especially, probably in great measure because the 
disease spreads by contagion freely amongst them. It 
occurs also in those who have all the advantages of social 
position and good hygiene. 

The eruption in the disease in the majority of cases 
appears first of all on the face, sometimes on the top or 
back of the head, and in the form of ''little watery 
heads " (vesicles) that enlarge into flat bullae if they are 
not injured by scratching. Sometimes the hands are 
attacked at the outset, and look as if burnt here and 
there; phlyctense may also arise out of and around the 
remnants of vaccinia, or about cuts or bruises. The dis- 
ease then extends to other parts, the back of the neck, but- 
tocks, feet, etc. The vesicles are always isolated. In five 
or six days the bullae may reach the size of a sixpence or 




p 



..J 



Impetigo Contagiosa. 



IMPETIGO CONTAGIOSA. 217 

shilling unless ruptured, and are then flat and depressed 
in the centre, their contents becoming turbid. Usually 
the vesico-pustule is the size of a large split-pea or there- 
abouts. The secretion consists of lymph-like fluid, gran- 
. iilar cells, and subsequently pus-cells. 

Scabs commence to form a few days after the appear- 
ance of the disease. They are characteristic of the 
-disease, varying in size from that of a split pea to a 
-shilling; they are flat, straw-colored, dry, and granular- 
looking, and appear as if " stuck on " to the part; they 
present, as a rule, no inflammatory areola around their 
circumferences, though this is the case in severer in- 
stances of the disease. If removed, little sores are 
observed beneath, more or less filled in by gummy-like 
secretion, or a little pellet of splastic lymph, and when 
the scabs fall off there is an erythematous base left 
behind, the hue of which gradually fades away. The 
disease may be spread from spot to spot by direct inocula- 
tion with its secretion in the act of scratching. The 
crop of vesicles is to some extent successive, though the 
majority of the places " come out " in the first week or 
so. In some instances the disease resembles vaccinia 
very slowly. There is always a uniformity about it; it 
always commences by vesicles; there are no papules 
present at the height of the disease. On the face the 
spots may be confluent, and then the disease resembles 
eczema impetiginodes; but the patches are made up of 
the elements described above. On the scalp the disease 
consists of circular, mostl}" isolated, flat-scabbed spots 
about the top and back of the head, the hair being matted 
by the crusts. Usually, no pediculi and no offensive 
smell are present. Now it is verj^ important to note that 
an eczema may be readily excited in fair children by 
scratching or the irritation of the discharge, in connection 
^5 



218 SKIN DISEASES. 

with impetigo contagiosa — and then the characteristic 
features of the latter disease are masked. The result of 
neglecting to attend to this point is that the practitioner 
regards the disease present as solely and entirel}^ an 
eczema. The error, too, is a very common one. 

The mucous membranes of the eye and the nose are 
sometimes implicated; then inflammation is produced by 
the development of little ulcers, that take their origin in 
the formation apparently of vesico-pustules, identical 
with those seen on the surface of the skin. The eye 
may look as though affected by slight purulent ophthal- 
mia, but soon recovers itself. 

The disease may complicate eczema, scabies, and other 
affections, and vice versa. 

Diagnostic features are — its apparently epidemic char- 
acter in many cases; the antecedent febrile condition; its 
attacking children; the origin from isolated vesicles, 
which tend to enlarge into blebs and to become pustular, 
the bleb having a depressed centre, and, it may be, a 
well-defined, slightly raised, rounded edge; the isolation 
of the spots; the u7iiform character of the eruption, and 
its general and scattered condition; its frequent seat and 
commencement about the face or head; the circular, fiat, 
granular, yellow crusts looking as if stuck on; its con- 
tagious nature and inoculability; its frequent follow- 
ing in the wake of vaccination; the absence of pain, and 
especially troublesome itching at night. 

Contagious impetigo may be confounded with eczema ; 
but the history is altogether different, and the isolation, 
the small scabbed patch, the characters of the crusts, and 
the facility of cure at once distinguish it. Impetigo 
sparsa does not arise from a vesiculation, but is primarily 
pustular, made up of aggregated pustules; it does not 
phlyctenoid; it is not contagious nor inoculable; it does 



IMPETIGO CONTAGIOSA. 219 

not run a definite course; it is not confined to the young; 
it is not so amenable to treatment. 

Pemphigus. — In this disease the blebs are larger, 
more persistent, oval, and distended; the contents are 
watery and acid. Pemphigus is non-contagious; it does 
not occur especially on the face or the head; it is less in- 
flammatory, and wants the characteristic scabs. Ec- 
thyma. — This is primarily a pustular disease; it is seen 
also in adults; there are more induration and swelling, 
and a good deal of pain in connection with the formation 
of pustules; it is non-contagious; the scabs are heaped-up 
and dark. Pustular^ scabies. — This is the disease with 
which contagious impetigo is at times confounded. It 
must be remembered that the two diseases may coexist. 
In children both attack the buttocks frequently; both may 
exist about the hands and feet; but the distinctions are 
really very clear. In scabies there is no febrile condition; 
the eruption is multiform. If there be ecthymatous pus- 
tules, like impetigo contagiosa, they are covered by dark 
thick crusts; there are plenty of characteristic vesicles, with 
cuniculi and papules. If the impetigo contagiosa begins 
about the buttocks, it appears presently on the face or the 
head, or both. There is no irritation, nor are the effects 
of scratching visible about the body as in scabies; the 
bullous origin of the disease is distinct, and the scabs are 
characteristic. The hands are not specially affected in 
scabies in the child, but even impetigo contagiosa may 
attack the hands and feet markedly; still there is no mul- 
tiform eruption, and there are no cuniculi in the latter. 

When a correct diagnosis is made, the treatment is 
easy. The natural course of the disease is a short and defi- 
nite one The secretion is an active agent, by means of 
inoculation self-practiced by the patient in scratching, in 
transmitting the disease from one part to another. There- 



220 SKIN DISEASES. 

fore it is of first importance to destroy the activity of the 
pus, and to alter the behavior of the surface that secretes 
it. A very active agent in procuring this result is an 
ointment containing five grains of the ammonio-chloride 
of mercury, and apply it to the surface beneath the scabs, 
which must be removed by poulticing or fomentation 
with warm water. A sulphur ointment is also beneficial. 
The patient must be well-nourished, and strict hygienic 
treatment adopted. Cleanliness is all-important. 

The old-school rely principall}^ upon the external ap- 
plications. 

The indications for the internal remedies are: 

Anti7}ion. criid — This is the principal internal rem- 
edy. Eruption forming thick, heavy yellow crusts, 
with burning; eruption about face; worse from bathing 
the parts; better in open air; chronic cases. 

Arsen. alb. — Black pustules, filled with black blood 
and fetid pus; painful sensation on scalp and face, as from 
cutaneous ulceration; worse from cold and touch; better 
from warmth. 

Baryta carb. — Especially old people; thick crusts be- 
hind the ears; fat dumpy children, with swollen lym- 
phatics; sore throat, with swelling of tonsils after the 
least cold; worse at night and when thinking of it; better 
in open air. 

Calcarea carb. — During dentition; dry crusts; sweat 
of forehead, particularly in the evening; sensitiveness of 
the roots of the hair. 

Cicuta vir. — Impetigo sparsa; eruption on chin and 
lower part of face, forming thick yellow crusts; honey- 
comb-like crusts, which fall off and leave a bright-red 
smooth surface; painful eruption on scalp. 

Clematis — Psoric constitution; pimples on forehead, 
root and sides of nose; pustules about lips, tender to 



IMPETIGO CONTAGIOSA. 221 

touch; large pustules about loins; eruption changes char- 
acter during the changes of the moon; worse in bed, 
washing, and towards morning; feels exhausted on wak- 
ing. 

Conium — Sero-purulent eruption in aged people, old 
hypochondriac maids; vertigo when turning over in bed, 
looking up; old, weak, and feeble men; scrofulosis, with 
engorgement of lymphatics; eruption around mons ve- 
neris. 

Croton Hgl, — Pustular eruption upon an inflamed base, 
with itching and stinging pain upon septum nasi, plug- 
ging the nostril; eruption on abdomen; sore nipples of 
nursing women. 

Euphorbium is indicated when there is an irritable 
skin, with swelling of the face and pea-sized yellow vesi- 
cles. 

Graphites. — Scabby eruption, with excessive oozing; 
eruption around mouth and nose or the whiskers; hair 
falls out; corrosive blisters about extremities, toes, and 
fingers; dry skin; very sensitive to cold; cold hands and 
feet, with scanty menses; rhagades. 

Hepar. — Eruption after mercurialism; sensitive to 
touch; tendency to ulceration; humid scabs and pustules 
upon the head, oozing a fetid substance; swollen cervical 
glands; cracks behind ears; hands cracked and dry. 

Iris vers. — Impetigo capitis, with gastric complaints, 
nausea, and vomiting. 

Kali bichrom. — Dry eruption; pustules disappear with- 
out bursting. Stands next to Antim. cr. as a remedy. 

Kreasotum. — Painless pustular eruption all over body, 
especially on chin and cheeks; sticking pain, especially 
on points; sad and weeping; worse in open air. 

Lycopodium . — After abuse of mercury; itching and sup- 
purating eruption on head and face; full of deep cracks; 



222 SKIN DISEASES. 

abundant and fetid discharge; fetid and moist scabs be- 
hind ears; humid tinea capitis. 

Mercurius. — Swelling and suppuration of glands; gas- 
tric derangement; moist scabs, with excoriation of the 
scalp and destruction of the hair; yellowish scabs on 
face, with fetid discharge; yellowish scabs, especially 
around mouth. 

Mezereum. — Deep inflammatory redness of face; erup- 
tion fat and moist; ichor from scratched places excoriates 
other parts. 

Nitric acid — Eruption on head, pricking on being 
touched; pustular eruption on face, with large red mar- 
gin and heavy scabs; mercurio-syphilis. 

Rhus tox. — Small pustules on black base; greenish pus, 
with violent itching at night; humid eruption, with thick 
scabs on face and head, destroying the hair, wnth fetid 
smell; eruption on nose, extending to face. 

Silicea. — Eruption resembling varicella; violent itching 
of scalp; moist scald head; growing pains; better 
warmth, worse from cold. 

Sulphur. — Dry, thick, yellow scabs on scalp, with pro- 
fuse discharge; great itching relieved by scratching; pur- 
ulent eruption on elbows. 

Tartar emet. — The remedy when the disease is exceed- 
ingly pustular. 

Thuja. — Eruption all over the body; itching and shoot- 
ing, especially at night; pustular eruption about the 
knee; better from gentle rubbing. 

Viola tricolor. — Pustules and scabs upon face, with 
burning and itching, and discharging fetid pus; sensa- 
tion as of tension of the integument of face; urine smells 
like cat's urine; worse at night. Recent cases. 



ECTHYMA. 223 

Ecthyma. 

This disease is described as consisting of isolated phlyza- 
cious pustules — namely, those which are "large, raised 
on a hard base, of a vivid red color, and succeeded by 
thick, hard, dark-colored scabs, beneath which there is 
ulceration." The pustules are generally distinct, round, 
and isolated; they are mostly general, but may be par- 
tial, and leave cicatrices behind. The shoulders, but- 
tocks, and limbs are the parts usually attacked. There 
are two chief forms described — acute and chronic. 

Acute general ecthyma is rare. The ordinary scattered 
ecthyma is practically always the result of the action of 
some irritant upon the skin, in an unhealthy or badly 
nourished subject; and so ecthymatous pustules frequently 
occur in connection with scabies and phtheiriasis, and 
more rarely in pruri, or eczema, and other diseases. 

Acute ecthyma commences with slight febrile disturb- 
ances, and occasionally sore throat; locally, there is first a 
sense of heat and burning, followed by the appearance of 
reddish raised points, with hard, indurated bases, and 
•distinct vivid areolae; these points, which vary in size 
from that of a pea to that of a shilling, quickly pustulate, 
and are often accompanied by acute, sharp pain. In two 
or three days the pustules give exit to discharge, which 
dries into hard, adherent, dirty, discolored scabs, covering 
over circular ulcerations; the crusts fall off in a week or 
so, leaving behind dark stains. The ecthymatous spots 
may be few or man}^; in the latter case a good deal of ir- 
ritation is set up; the patient may be unable to sleep from 
pain, and the glands and lymphatic vessels may become 
inflamed, small abscesses forming subsequently. The 
disease is generally protracted by successive crops of pus- 



224 SKIN DISEASES. 

tules, or it may relapse into a chronic state. The limbs^ 
shoulders, and trunk are chief seats of the disease. 

Chronic ecthyma generally results from the action 
of some irritation, as in scabies, in connection with pedi-- 
culi, and from scratching and badly nourished subjects. 
The ecthymatous pustules in the chronic disease are of 
similar character to those of acute ecthyma. They are 
painful, with hard, inflammatory bases and a small central 
collection of pus. When they occur on the limbs, espe- 
cially the legs, in old people they are followed some- 
times by troublesome ulcers. 

In ecthyma the seat of disease appears to be the upper- 
most layer of the derma, not unlikely about the glands of 
the skin, the depth of surface involved being less than in 
furunculus, and there is no "core," otherwise ecthyma 
would be well classed with boils. The tendency to ulcer- 
ation and sloughing, the lividity of the inflammatory 
areola, the disturbance of the general system, all point to 
a cachectic condition. 

Causes. — The predisposing causes are always such as 
lead to debility and an impoverished state of blood. 
They are, in infants, bad nursing, suckling by mothers 
much out of health, scabies, bad clothing, damp dwell- 
ings; in adults and others, over-work, fatigue, convales- 
cence from acute diseases, bad food, privations, various oc- 
cupations that induce irritation of the skin, as bricklay- 
ing, excesses of all kinds, debauchery, uncleanliness, 
night-watching, overcrowding in public institutions — 
workhouses, jails, and such like. The immediate excit- 
ing causes are scabies, phtheiriasis, the use of acrid 
medicinal applications, and scratchiiig. 

Prognosis is to be made according to the general con- 
dition of the patient. The ecthyma, per se, is of little 
gravity, save when it is accompanied by sloughing, as in 
old people; then it is grave. 



ECTHYMA. 225 

Diagnosis. — The distinct, large, isolated pustules, 
with an inflamed areola and hard base, distributed over 
the body, are very distinctive of the disease. It may be 
confounded with impetigo sparsa, but in this disease there 
are rather sero-pustules than pustules, which are very 
superficial; the discharge is viscid, yellowish; these areas, 
dark scabs, no indurated, inflamed, and painful bases. 
Furunculus is deeper, it runs a slower course, and con- 
tains a central " slough " or " core," as it is called. It 
is more circumscribed, and there is little scabbing. 

Treatment. — lyocally a good application is an oint- 
ment made by rubbing together an ounce of lard, and 
half a drachm or so of Friar's balsam. The crusts may 
be removed after soakings with oil, and the affected parts 
dressed with an ointment made by adding five to ten. 
grains of white precipitate to the ounce of cosmoline. 
After the pustules burst, if the ulcers show but little 
tendency to heal, a weak carbolized wash may be used. 

The patient should be well hygiened and given a good 
generous diet. 

The appropriate internal remedy ma^^ be .selected from 
the following: 

Aiiacardium . — Hard, red pustules, itching worse after 
scratching; crossness and irritability with weakness of 
mind; sensation of a hoop around the affected part. 

Antimon. crud. — Pustules on the face in fat people;, 
yellowish or brownish scabs on the face; desire for acids. 

Arsen. alb. — Red or white pustules, with intense burn- 
ing; painful black pustules, gnawing, burning, and 
itching; eruption on the scalp, forehead, around the e5^es, 
cheeks, arms, shoulders, and upper part of the chest, 
terminating in thick crusts, and leaving well-marked 
scars. 



226 SKIN DISEASES. 

Aurum. — Pustules on the face, neck and chest, with 
irritabiUty and melancholy. 

Bellad. — PUvStules surrounded by a whitish areola. 
Burning and itching with great sensibility to touch. 

Caladium. — White pustules with red areolae, sore to the 
touch and itching; better from sleep in the day time. 

Calcarea carb. — Heat, thirst and loss of appetite accom- 
pany the eruption. Scrofulous children and during den- 
tition. 

Cantharis. — Tendency to ulceration and gangrene, 
after or with the exanthemata; debility and emaciation. 

Ciciita. — Burning suppurating eruption about the face, 
with yellowish crusts. 

Croton tigl. — Confluent pustules with oozing and burn- 
ing; greyish-brown crusts on the abdomen; pustules 
with scarlet redness of the skin; itching followed by 
painful burning; pains relieved after sleep; intense itch- 
ing, but cannot bear to scratch on account of the pain it 
causes. 

Cyclamen. — Pustules on the feet and toes. 

Hepar. — Great sensitiveness of the pustules to the 
slightest touch; redness or little pimples around the ul- 
ceration. 

Kali bichr. — Pustules all over the body, in the early 
stage having a small brown scab on the top; pustules 
at the root of the nails spreading over the hand; pustules, 
with violent itching, which dry without bursting, form- 
ing scabs which sting and burn; pustules resembling 
small-pox, with a hair in the middle, leaving after the 
scab comes off a small dry ulcer, which heals in about a 
fortnight, leaving a colorless depressed cicatrix; eruption 
more in hot weather. Light-haired children inclined to 
grow fat. 

Kali hyd. — The eruption is profuse, over the body. 



ECTHYMA. 227 

Great desire for the open air. Catarrhal fever with 
violent thirst. 

Kreasotum. — Large, fat greasy pustules, with violent 
itching towards evening; sensation in the skin as from 
ulceration, especially on face and chin. 

Larhesis. — Eruption more on the arms and left side; 
constitutional taint; feels worse after sleeping. 

Mercurius. — Suppurating pustules, which either run 
together, discharging an acrid humor, or which remain 
sore, become hollow, and afterwards raised and cicatrized; 
pustules bleed easily and are painful to the touch; itching 
and burning from the warmth of the bed; sweats easily 
without relief. 

Nitric acid. — Feeling as of a splinter sticking into the 
pustules when touching them. 

Petroleum. — Itching and burning pustules, with great 
weakness on exertion; great lassitude; worse in fresh air. 

Piper nigrum. — Large pustules leaving marks on the 
face. 

Rhus tox. — Pustules seated upon a red base; black 
pustules, forming hard scabs, with burning and itching; 
worse at night and in cold and stormy weather. 

Secale corn. — Cachectic females, with rough skin; pus- 
tules on the arms and legs, with tendency to gangrene. 

Silicea. — Pustules all over the body, especially on the 
back part of the head, sluggish, and do not suppurate or 
dessicate; sensitive to contact; burning and soreness after 
scratching; aversion to warm food; worse in cold. 
Scrofulous diathesis. 

Sulphur. — Dry, thick, yellowish scabs all over the 
body, especially on the scalp; always attended with great 
itching; painful to touch; aversion to washing. 

labacum. — Eruption most on neck and upper limbs; 
weariness, languor and debility; death-like paleness, 
nausea worse on least motion. 



228 SKIN DISEASES. 

Tartar emef. — Eruption over the wbole body. Pustules 
are full, large, round, burning and painful with red 
areolae, soon drying up and leaving deep malignant 
ulcers. Pale,- livid, blackish, depressed pustules filled 
with blood or bloody serum collapsing on bursting and 
changing to broad, deep ulcers. 

Thuja. — Suppurating pustules, especially on lower ex- 
tremities; worse from touch; relieved by gentle rubbing. 

Furuncle. 

A furuncle, or common boil, needs little in the way of de- 
scription, the features being so familiar to all. Patholog- 
ically considered, it may be described as an acute and 
painful localized inflammation, differing, however, from 
a simple abscess by the fact that in the furuncle we find a 
central core of necrosed cutaneous and connective tissue, 
around which the inflammation is developed. Modern 
investigation leads us to the supposition that a micro- 
organism, having gained an entrance into one of the 
follicular openings, sets up changes which result in the 
death of the tissue in the immediate vicinity. This 
necrosed tissue acts as a foreign body and excites inflam- 
mation, as would a thorn, and after a few days the hard, 
painful, red tubercle exhibits a drop of pus at its summit, 
which gradually increases until the entire lesion softens, 
and finally breaks, with exit of pus, together with the 
core referred to. 

The pus which is discharged from a furuncle appears to 
be capable of exciting new lesions of a similar nature, and 
crops of boils may follow each other in an extremely per- 
sistent and disagreeable manner. 

Abortive Treatment. — If a furuncle comes under the 
treatment at the beginning, there is little doubt but that 



FURUNCLE. 229 

it can be aborted; and one way to do this is to insert the 
sharp point of a PaqueHn cautery, or a lance-shaped 
galvano-cautery. If neither be at hand, a pointed stick 
of nitrate of silver should be thoroughly bored in. This 
is painful at the moment, but it saves pain later on, and 
may be the means of preventing the formation of new 
boils. Another method recommended is to scrape the 
skin over the threatened seat of invasion with a scalpel 
until a drop or two of blood exudes on pressure. 
Another: 

R. Hydrargyr. oxid., o. lo; lanolin, lo.o. S. To be 
well rubbed in three or four times daily. This will fre- 
quently be successful in aborting a boil. 

Sen recommends the following abortive treatment for 
furuncles: i. Carbolic acid in hypodermic injections. 2. 
The acid must be used early before suppuration appears, 
in which case the furuncle will be aborted without any 
connective tissue necrosis. 3. In advanced cases the 
adoption of the same treatment will prevent serious scar- 
ring. 4. A three per cent, solution is of more value than 
a weaker one. 5. Patients can follow^ their usual occu- 
pations during the progress of the treatment. 

Furuncles should never be opened with a knife until 
they are "ripe" — that is, until the accumulation of pus 
has been sufficient to loosen the central core. When 
opened, however, the pus should be evacuated as thor- 
oughl}^ as possible, and the central core removed. The 
parts should then be thoroughl}^ cleansed with mercurial 
solution, and an antiseptic dressing applied. The sul- 
phide of calcium given internally, in doses of one quarter 
of a grain, hastens the maturation of the lesions. 

When a boil is tense and hard, the best local treatment 
consists in applying hot, limited flax seed meal, or pul- 
verized slippery elm, or tomato poultices. Poultices 



230 SKIN DISEASES. 

should not be continued after the boil opens, as if too 
long used they rather encourage the formation of new 
boils. Gelsemium or lappa cerate is a good after-dressing. 

The appropriate internal remedy will usually be one of 
the following: 

Absinthium. — Eruption of furuncles over the whole 
body. 

Aethusa. — Painful boil on the small of the back; he- 
patic derangement; intolerance of milk; in children dur- 
ing dentition. 

Ammon. carb. — Boils on the cheeks and around the 
ears; in scrofulous children and in old people. 

Antimo7i. rr/^^f.— Boils on the perineum; burning pain 
for some distance around; gastric derangement. 

Arctium lappa, — When crops of boils persistently oc- 
cur; hordeolum and ulcerated eyelids. 

Arnica. — Many small boils on the face; eructations bit- 
ter and like rotten eggs; general lassitude. 

Apis. — Boils on the pubis; burning, stinging pains; 
great sensitiveness to touch and pressure. 

Bellod. — In early stages, if boil is inflamed and pain- 
ful; red, hot, shining swelling; boils on the shoulders 
every spring; after measles. 

Bellis per. — Boils beginning as slight pimples, and in- 
creasing to large dark colored swellings, with aching 
pain. Mostly on the neck and lower jaw. 

Berberis vulg. — Hastens suppuration in boils, and pre- 
vents their recurrence. 

Bromide of potassium causes an eruption of small boilsy 
in successive crops, chiefly over the face and trunk, with 
troublesome itching. 

Bromine. — Boils on the arms and face. In light-haired, 
blue-eyed persons. 

Cadmium sulph. — Boils on the nose and buttocks. 



FURUNCLE. 231 

Calcarea carb. — Boils on the forearms and hands, with 
lancinating pains; cramps in the arms; glandular swell- 
ings. In scrofulous persons. 

Calcarea mur. — As a preventative. 

Carbo afi. — Boils at the anus; burning, tearing pain. 
In scrofulous subjects. 

Ci7ia. — Boils on the head and face in children; child is 
very fretful; bores in the nose with the fingers; burning 
heat of the face with a glowing redness of the cheeks. 

Cistus. — Boils beginning with a blister. 

Gelsemiujn. — Large boils on the face and neck; great 
muscular prostration; sleeplessness from nervous irrita- 
tion; dizziness and blurred vision; heat of face and head. 

Hepa7\ — When boils mature slowly; violent throbbing 
gathering pain; stinging soreness; after injuries. Hepar 
low to promote suppuration, and /ilgk to prevent suppura- 
tion. 

Kaliiod. — Papular eruption, or other eruptions with 
strumous or syphilitic taint. 

Kalmia /<2^. — Red inflamed spots like incipient boils. 

Lappa?naj. — Boils on the face, eyelids and all over. 

Ledum. — Boils on the forehead, itching, pricking tear- 
ing pains worse in the evening before midnight. After 
mosquito stings. In drunkards. 

Lycopod. — Boils on the nates; periodical boils; aggra- 
vated by warm, wet poultices; after excessive wnne drink- 
ing. 

Manganum. — Small boils; every injury tends to sup- 
purate. 

Magnesia mur. — Boils on the nose which suppurate in 
one day; boils on the false ribs; menstrual derangements; 
diarrhoea in children. 

Merc. sol. — Boils on the ankles; coldness of the hands 
and feet; foetid ulcers on the legs, with gnawing itching; 



232 SKIN DISEASES. 

shooting tensive pains, worse at night; especially when 
complicated with bilious or mucous diarrhoea. 

Natrum carb. — Boils behind the ears; ulcers on the 
limbs; burning in the feet when walking; sour eructions. 

Nitric acid. — Numerous large boils on the scapulae, 
nape of the neck, nates, thighs and legs; tensive pains 
worse in the evening and at night; aggravated by drink- 
ing milk. 

Nitrum. — Boils on the thumb. 

Nux juglans . — Boils on the right arm; indurated boils; 
blood boils; violent itching and burning. 

Nmx vom. — Boils on the knees; gastric derangement; 
constipation. 

Phos. acid. — Boils in the axillae, and on the nates; 
burning, stinging pain; skin feels sore all over. In 
young people who grow rapidly. 

Phytolacca. — Boils on the back. 

Rhus rad. — Boils on the face which do not mature; 
blind boils. 

Silicea. — Boils on the posterior portion of the thighs, 
and on the calves; disposition to boils; constipation. 

Stramon. — Boils on the feet; coldness of the limbs in 
children. 

Sulphur. — Boils in the ear; stinging itching with 
smarting after scratching; after suppressed menstruation; 
disposition to boils. 

Zinciun ox. — Boils on the abdomen, aggravated by use 
of wine; worse before and during menstruation. 

Hordeolum, or Stye, 

Is a small boil seated at the edge of the eyelids and in- 
volving a Meibomian gland. It is not an active kind of 
boil, but progresses sluggishly, the pustule centre being 
small. It is painful, and some time lapses before all 



ANTHRAX, OR CARBUNCLE. 233 

traces of its existence go. There may be one, two, or 
more on one or both eyelids. Some persons are subject 
to repeated outbreaks of this furuncular inflammation. 
We find it most frequently in youthful individuals of 
rather delicate health with a tendency to acne, or in per- 
sons addicted to free living or dissipation. If by frequent 
relapses it induces inflammatory changes in the Meibo- 
mian glands, and is followed by fatty or chalky degener- 
ation of their contents, it is called Chalazion. 

Indications for the internal remedies are: 

Graphites. — Frequent recurrence of styes, ulcerations 
of the margins of the lids; biting lachrymation. 

Lycopod. — Styes on lids near internal canthus. 

Pulsatilla. — More in affections of lower lids, conjunctiva 
injected, agglutination of lids in the morning; much 
swelling of lids; burning, drawing pain, w^orse evenings, 
in warm room, and in a cold draft, better in fresh air; 
catarrhal states tending to suppuration. 

Staphisagria. — Affection of both lids, especially the 
upper ones; consequences of nervous exhaustion, the affec- 
tion does" not spread to the surrounding tissues; shooting, 
lancinating pains or tearing, mostly in paroxj^sms, worse 
during night; new ones form continually and leave small 
hard nodules at the tarsal edge. 

Anthrax, or Carbuncle, 

Is a multiple furuncle. It arises as a hot, hard swell- 
ing, not so conical as that of the boil — more indurated, 
however, the cellular tissue around being much more ex- 
tensively indurated; its color is dusky, the sensation 
burning, dull, throbbing; the carbuncle varies in size, 
the swelling becomes *' brawny," from the meshes of the 
cellular tissue becoming filled with a plastic lymph. The 
next step is the formation of a quasi-Qhs,ZQ.ss', the central 
i6 



234 SKIN DISEASES. 

part of the swelling softens, and feels boggj^; the skin be- 
comes thin over the surface, and at several points open- 
ings occur, through which slowly issues more or less 
sanious pus; and the little holes are seen to be plugged 
up by small white cores, which presently loosen and 
come away; the apertures are red and papillated, the 
edges indurated and everted, particularly when several 
openings coalesce, so as to form one or more large open- 
ings. Gangrene may set in. The healing process is 
often indolent, the parts remaining undermined, brawny, 
dusky, shreddy, and also sloughy. Carbuncles are gen- 
erally solitary. The patient, if the attack be severe, gets 
into a very depressed state. The posterior aspect of 
elderly people is the selective seat of carbuncle. 

In carbuncles there are similar changes to those in 
boils, but a much severer degree of disease. Here a 
group of sebaceous glands is involved, and in conse- 
quence of the more cachectic state of the nutrition the 
reparative attempt is less perfect, the inflammation is of 
a lower type, and the cellular tissue sloughs and dies to a 
much greater extent. The nutrition is not only unequal 
to prevent the local disorder, but also incapable of putting 
repair in proper operation; and there is one disposition 
in carbuncular subjects that perhaps has a peculiar in- 
fluence in disposing to sloughing and gangrene of the 
cellular tissue; this is the tendency to, or an actual, 
diabetic habit. Sugar occurs in the pus of the carbuncle, 
and it is a curious fact that when anthrax develops the 
sugar is diminished or disappears from the urine. 

In summing up the conditions under which boils occur, 
it will not be difiicult to classify the main ones as follows: 
I. during seasonal changes in spring and summer; 2. 
from eating diseased meat (frozen); 3. when any special 
alteration is made in the ordinary habits and economy of 



ANTHRAX, OR CARBUNCLE. 235 

the body, as in the training of prize-fighters; 4. from the 
influence of cadaveric poisons; 5. from sudden change 
of diet; 6. after fatigue of long duration; 7. during 
convalescence from debilitating diseases; 8. as a conse- 
quence of the action of septic poisons, as in fevers, etc. ; 
9. in albuminuria; 10. in the diabetic habit; 11. dur- 
ing adolescence, and in the first stage of manhood. In 
most of these cases there are ' ' debility ' ' and an over- 
loaded state of system — for example, the circulation of 
urea, of sugar, of septic poison, or of effete matter which 
is plentiful during convalescence; and it only needs the 
action of some local irritant to determine the develop- 
ment of furunculi in the parts to which that irritant is 
applied. 

Diagnosis of Boils and Carbuncles. — No error can 
possibly be made in respect to these two diseases; in the 
former the hard, deeply-seated induration, the pain, the 
central suppuration, and the ''core," are distinctive. 
The manifold openings, the boggy feel, the sloughing, 
the grumous discharge, and the implication of the cellu- 
lar tissue in carbuncle are very peculiar. Furunculi are 
sometimes epidemic. 

Treatment. — I would add one word of caution in re- 
gard to the use of poultices: The poultices should be 
confined as much as possible to the exact seat of local in- 
flammation. Nothing is more common than the spring- 
ing up of fresh around old boils from the neglect of this 
precaution. The same local measures as recommended in 
furuncles are useful here. In addition consider the fol- 
lowing: 

The early application of ice and salt bags to the swell- 
ing is said to lessen the extent of the disease. If the 
sloughing is extensive charcoal and yeast poultices may be 
used. The sloughs should be picked out as fast as they 



236 SKIN DISEASES. 

loosen, and the ulcer washed out once or twice a day with 
a weak solution of carbolic acid, or peroxide of hydrogen. 

Dr. Owen, of London, treats large carbuncles with ex- 
tensive sloughs by removing the sloughs, under an 
anaesthetic, scraping the sores and the diseased under- 
mined skin with Volkmann's spoon and trimming off the 
ragged edges. The wounds are then washed with a 
i-iooo sublimate solution, dusted with iodoform, and 
covered with moist perchloride gauze and blue wool. Do 
not use the knife to open a carbuncle. 

The indications for internal remedies are as follows: 

Aconite. — As an occasional remedy, when there is much 
inflammation with high fever. 

Anthraciyium . — When the burning pain is violent and 
not relieved by Arsenicum; cerebral or typhoid symptoms; 
evidences of blood poisoning; sloughing, abundant dis- 
charge of ichorous, terribly smelling pus. 

Apis. — Continued extension of the erysipelatoid inflam- 
mation with stinging burning. 

Arctium lappa. — Has great reputation; used both inter- 
nally and locally. 

Arse?i. alb. — Large, painful and malignant carbuncles; 
great prostration; great restlessness; great thirst, drink- 
ing but little at a time; all the symptoms are worse 
in the night, and better from external warm applications. 

Bellad. — Bright redness, with throbbing pain; when 
cerebral complications arise; erysipelatous inflammation 
around the carbuncle; drowsiness with inability to go to 
sleep. 

Biifo, at the commencement very efficient. 

Car bo veg. — Dark blackish appearance of the sore; 
fetid odor of the discharge; hippocratic face; blood poi- 
soning. 

Ciitchona. — When the asthenic character of the disease 
is well marked; debility from excessive suppuration. 



PUSTULA MALIGNA. 237 

Hyoscyamus. — When there is great restlessness, caused 
by excessive nervous excitement; itching around the 
swelling; in nervous and hysterical individuals. 

Lachesis. — Bluish purpHsh looking carbuncles, with 
evidences of blood poisoning; nightly burning, obliging 
one to rise and wash parts in cold water; inability to bear 
any bandage around the neck; cerebral symptoms. 

Muriatic acid. — Carbuncles in scorbutic individuals, 
with ulcers on the gums; frequent desire to urinate with 
profuse emission of clear urine. 

Nitric acid. — When there is a predisposition to anthrax. 

Phytolacca. — Tendency to carbuncles, especially on the 
back and behind the ears. 

Rhus tox. — Great restlessness; feels somewhat relieved 
of the violent pain as long as he is in motion; burning itch- 
ing around the carbuncle, with vertigo; bloody, or serous, 
frothy, diarrhoea; typhoid symptoms. 

Secale corn. — Carbuncles on the arms; aggravated by 
warm applications; gangrenous tendency. 

Silicea. — During the process of ulceration, to promote 
healthy granulation. 

Pastula Maligna, Malignant Pustules, 

Also called Carbunculus contagiosus, is characterized by 
the appearance of an angry-looking pustule, associated 
with gangrenous destruction of the surro.inding pares 
which owes its origin either to a direct inoculation of the 
poison from an animal affected with the disease called 
Anthrax, or Charbon, or to a transmission by flies of the 
poison, or to inoculation of the poison from man to man, 
or to the eating of the flesh of diseased animals. It is there- 
fore most frequently found among persons wdio have to 
do with diseased animals, or who work in manufacturing 
establishments, where the products of such animals 



238 SKIN DISEASES. 

(hides, horsehair, wool) are prepared for different uses. 
The infection 'takes place principally on the uncovered 
parts of the body which are exposed to the entrance of 
the poison. The eating of diseased flesh first causes gen- 
eral malaise and intestinal troubles, after which, in about 
eight or ten days, anthrax carbuncles appear, by prefer- 
ence on the arm, forearm and head. 

After an incubation of from a few hours to several 
days, there is at first felt on the spot where the poison took 
hold a slight burning and itching, as if from the bite 
of an insect, and one can see a little red speck with a 
black point in its centre. This soon becomes changed 
into an itching papule, capped with a small, generally 
reddish or bluish vesicle, which gradually enlarges. Af- 
ter bursting it discloses a dark red base, which becomes 
covered with a crust, while often, though not always, sec- 
ondary vesicles spring up around it, which contain a yel- 
lowish, reddish or blackish fluid. At the same time the 
surrounding parts swell oedematously over a considerable 
area, the cellular tissue underneath also becomes infil- 
trated, and in many cases discolored lines mark the 
course of the veins, or red stripes the course of the lym- 
phatic vessels in the oedematous region; the corresponding 
lymphatic glands also swell. The general symptoms cor- 
respond with the severity of the local affection; there is 
fever, great weakness, delirium, excitement, confusion; 
sweating, diarrhoea and pain in the extremities; in fatal 
cases collapse; in favorable cases after the dead masses 
have been removed by sloughing off, the wound gradu- 
ally heals by healthy granulation. 

The indications for internal remedies are few: 

Lachesis. — Bluish color of the pustule and red streaks 
along the lymphatic vessels. 

Anthi^acinum. — Blood poisoning. 



PUSTULA MALIGNA. 239 

Mala7idrinum . — Blackish diarrhoea; pain in back and 
limbs; pustule similar to a badly-looking vaccine pustule. 
Compare the remedies given under Carbuncle. 



CHAPTER XI. 

SQUAMOUS INFLAMMATION. 

General Remarks. 

There are two important diseases of the skin with 
which we shall deal in this chapter — namely, pityriasis 
and psoriasis. In the former malady, in its typical form, 
the surface of the body is deeply reddened (hypersemic), 
and covered by large and freely imbricated scales or 
flakes; hence the term applied to it — pityriasis rubra. 
In the disease there is no real inflammation in the form 
of new products. Hebra allies it to eczema, and upon the 
ground that ' ' we occasionally find moist excoriated 
patches on other portions of the skin, especially in the 
flexures of the joints." But this is infinitely rare; from 
beginning to end, there need be nothing but hypersemia 
and scaliness present in the disease. 

There is not necessarily any change in the corium 
tissue or the connective tissue, though the hypersemia, 
if persistent, maybe followed by hyperplasia and thick- 
ening of these parts, but only as accidental epiphe- 
nomena. 

In psoriasis a somewhat different state of things 
obtains; there is hypersemia of the papillary layer of the 
skin, with hyperplasia of the epithelial elements, but I 
believe the latter to be the more important of the two; 
and in this respect psoriasis contrasts with pityriasis 
rubra — the former being essentially a disease of cell 
tissue, the latter rather an hyperaemia, primarily. 



PITYRIASIS RUBRA. 241 



Pityriasis Rubra. 

Under this title two distinct types of disease have been 
described — the one by Devergie and the other by Hebra. 
They both possess certain marked features which would 
entitle them to the designations they have received; but, 
as there are also marked differences in their course, and 
prognosis, they must and should receive separate consid- 
eration. 

Pityriasis Rubra (Devergie). 

This affection is chiefly met with in persons between 
the ages of forty and fifty, and commences by the ap- 
pearance of well-marked redness, wath a sharply limited 
margin on the anterior aspect of the trunk and limbs. 
As it advances new surfaces are invaded, the skin 
slightly thickens, and the increase may be so rapid that 
the entire skin may become involved in from two to four 
weeks. Accompanying this diffuse redness we find free 
desquamation or exfoliation of medium-sized epidermic 
scales, with more or less watery exudation, resembling 
sweat rather than the l3miphy and plastic exudation of 
eczema. There is also an intense burning heat of the 
surface, so that the patient suffers from the warmth of 
his clothing and of the bed coverings at night. 

The acute symptoms mentioned are tenacious, and the 
affection m^ay persist in this condition for months, but in 
perhaps the majority of cases they gradually subside, and 
recovery takes place. 

On the other hand, the acute phase of the disease may 
be followed by one that is subacute, but more persistent, 
and continue to harass the patient for years, gradually 
breaking down his health and terminating fatally, 



242 SKIN DISEASES. 

through the supervention of chronic diarrhoea or the de- 
velopment of pemphigus. 

The prognosis is in the main favorable, except when it 
occurs in aged or debilitated subjects, or assumes the dis- 
tinctly chronic form. 

Pityriasis Rubra (Hebra). 

Under this name Hebra has described a disease that is 
wholly different from the foregoing, and the principal 
characters of which are as follows: 

The skin presents a persistent deep-red coloration, dis- 
tributed over the entire surface, but without papules, 
vesicles, or any exudation. Scales are found in small 
numbers, but do not become a prominent feature of the 
affection. 

The local subjective symptoms are insignificant. 

The progress of the disease is remarkably slow, and 
in its early periods the general health is not notably 
affected; but little by little there is a gradual weakening 
of the vital forces, and fatal marasmus marks the termi- 
nation of the patient's sufferings. 

It will be seen from the foregoing that the affections 
described under the same name by the eminent French 
and German authors differ from each other in every im- 
portant respect, and are, in fact, quite distinct diseases. 

Dr. Piffard has met with a number of cases of Dever- 
gie's disease, but only a single undoubted example of the 
malady described by Hebra. 

- If, as asserted by Hebra, pityriasis rubra is always and 
unnecessarily fatal, treatment other than palliative is out 
of the question. 

In Devergie's affection, however, every effort should be 
made to cut short its progress, and benefit may be ex- 
pected from baths, emollients, and therapeutics. 



PITYRIASIS RUBRA. 243 

Soothing local applications, such as bran baths or a de- 
coction of walnut leaves followed by oil}^ inunctions, and 
later by oil of white birch, are important aids. Lotions 
with corrosive sublimate i-iooo, or with hydrate of chlo- 
ral 1-50 or i-ioo, constitute an excellent application in 
pityriasis capitis. Sulphurated pomades have been ad- 
vised; flowers of sulphur 1-30 or 1-60. For pityriasis of 
the face a pomade of calomel i-ioo is often eflQcient. 

Arsenicum album is the principal internal remedy used 
by both schools. It produces pityriasis by its physiolog- 
ical action; its well known characteristics indicate its use; 
feverishness, with restlessness and thirst, for small quan- 
tities, etc. 

Natru7n ajsenicum. — This drug corresponds very 
closely to the leading peculiarities of this disease, and I 
have prescribed it successfully in several cases. Its skin 
symptoms read: "Squamous eruption, scales thin, 
white, and when removed leave the skin slightly reddened. 
If scales remain they cause itching, worse when warm 
from exercise." 

Arsen. tod. and Kali ars. are preparations that may be 
occasionally useful. I have had no trustworthy expe- 
rience with either. 

Other remedies may be indicated as follows: 

Antim. crud. — Brownish-red spots, like small hepatic 
spots, here anci there. 

Cajitharis. — Itching, followed by burning, when 
scratching; tendency to formation of blisters; most suit- 
able when the disease appears in children. 

Cocculus. — Red, irregularly shaped spots on the skin, 
over the whole chest, and on the sides of the neck, be- 
hind the ears, without heat or itching^ intolerance of both 
cold and warm air. 

Conium. — Frequently recurring red, somewhat itching, 
spots on the body. 



244 SKIN DISEASES. 

Graphites. — Pityriasis capitis, dryness of the skin, with 
cracking; localization of the eruption; tendency to cold 
from draughts of air; pains from changes of the weather; 
abundant desquamation from the hairy scalp. 

Kreasotum. — Uneasiness during rest, with irritation 
throughout the body; child cannot sleep unless carried or 
fondled; scaly ulceration on face, elbows, wrists and 
fingers. 

Lachesis. — Small reddish spots on face, neck and chest, 
which increase in numbers, become scurfy, and then dis- 
appear. 

Ledum. — Aching, bruised feeling in the whole body; 
warm sweat of the hands and feet; bluish spots on the 
body like petechiae; eruption itching, with anxiety; cold- 
ness in affected parts. 

Mezereum. — Chronic pityriasis capitis, loss of hair and 
great itching, brownish miliary rash on the chest, arms 
and thighs; phlegmatic temperament, with light hair. 

Phosphorus, — Brown, bluish-red, or yellow blotches on 
abdomen and chest. 

Sepia. — Brown-red hepatic spots on the skin. 

Sulphur \?, advised by the two schools. Its pathoge- 
nesis contains the formation of furfur. 

Tartar e7net. — Eruption dependent upon gastric de- 
rangement, nausea and vomiting, with thick white coat- 
ing on tongue. 

Pityriasis Pilaris. 

Devergie, who was the first to describe this rare der- 
matosis, states that in its most benign form it consists of 
a more or less localized eruption on the external aspects 
of the members, and especially the forearms and legs. 
The essential seat of the eruption is at the pilous orifices 
of the general surface, but not on the scalp. The only 
lesion is a minute papule, with a small adhering scale. 



Psoriasis. 



PSORIASIS. 245 

In more severe cases it may become generalized, with 
slight thickening of the skin about the follicle, forming a 
small, red pyramidal papule decked with a white scale. 
The skin between the papules is apparently unchanged. 

There is little or no pruritus, and it apparently causes 
but trifling inconvenience to the patient, except as it pro- 
gresses from bad to worse. 

It is exceedingly obstinate, and palliative and emoUient 
treatment is our only resource. 

When associated, as it may be, with pityriasis rubra, it 
presents a striking likeness to lichen, rubra and may pos- 
sibly be in reality the same affection. 

There is considerable discussion as to whether pityri- 
asis is not a parasitic affection. Some observers claim to 
have discovered a special parasite in this affection, con- 
sisting of very minute spores, averaging a thousandth of 
a millimetre in diameter. The extreme smallness of the 
spores and their irregularity in size have induced M. Vi- 
dal to name the parasite Microsporon' anomoeon or dispar. 

This is a point that has not been fully settled as yet, 
and I prefer to class the disease among the squamous in- 
flammations until further light has been thrown upon the 
subject. 

Sepia and Natr. ars. are the principal internal remedies 
for pityriasis pilaris. 

Psoriasis. 

Psoriasis is a constitutional disease, characterized by 
cutaneous lesions of the squamous type. 

This affection may appear in the early years of child- 
hood, or at almost any later period up to and including 
so-called middle life. It rarely appears at either of the 
extremes — that is, during infancy or old age. 

Its first manifestations usually take the form of small 



246 SKIN DISEASES. 

red papules, soon decked with a white scale. These may- 
be few and scattered, or many and closely aggregated. 
The scaly papules increase at their periphery, becoming 
flattened patches from the size of a pea to that of a coin 
or even larger. When the progress of the disease con- 
tinues, neighboring patches encroach on each other, and 
in time coalesce, giving rise to irregular gyrate forms. 
Coincident with the peripheral extension there is an in- 
crease in the infiltration or thickening of the skin, and 
the scales become large, imbricated, and more or less ad- 
herent. On forcible removal of the scales, a red infil- 
trated patch is brought to light, on the surface of which 
minute droplets of blood may be seen. After the disease 
has attained its maximum development, which may in- 
clude the greater portion of the surface, it may remain 
stationary for an indefinite period, or may undergo a 
gradual involution and disappear. This is the course fol- 
lowed in not a few cases of mild type. A single attack 
of this sort, howeVer, is exceedingly rare. In almost 
every instance the eruption reappears after a shorter or 
longer interval. In not a few cases of mild type there 
will be an appearance of the lesions at the beginning of 
the cold and a disappearance of them at the beginning of 
the warm seasons. 

In cases even where the eruption is caused to disappear 
by treatment there is the same tendency to return, and 
this relapsing feature of the disease is one of its most im- 
portant and most annoying characteristics. To such an 
extent is this true, that even with the most judicious treat- 
ment there is no certainty of a radical cure. As a rule, if a 
person once has psoriasis, he may expect to have it al- 
ways — that is, with certain intervals of freedom. The 
reverse of this is rare, as it is extremely exceptional for a 
patient to recover permanently, or to enjoy immunity for 
a term of years. 



PSORIASIS. 247 

The subjective sj^mptoms are usually unimportant, 
amounting at most to a moderate degree of pruritus^ 
though in man}^ cases this is not sufficient to be com- 
plained of by the patient. 

The eruption frequently exhibits a more or less sym- 
metrical disposition, and prefers the extensor surface, with 
a special predilection for the elbows and knees. The 
upper half of the body usually presents more lesions than 
the lower. It very rarely affects the palms or soles. 
When situated on the genitals it may excite an analogous 
condition of the mucous membrane. 

The features of the disease are the more characteristic 
if account be taken of its negative signs; for in it there is 
an entire absence of any discharge, vesiculation, or pus- 
tulation throughout the whole course of the disease. 
The characteristics above described constitute a primary 
condition . 

The eruption affects (by preference) certain parts of 
the skin whose epithelium is thick, especially the elbows 
and knees. It may be partial or general. At the outset 
the disease may be attended by more or less pruritus. 
The increase of the patches is by centrifugal growth, 
and there is oftentimes a slightly red margin; the scales 
are shed, to be again replaced by others; in chronic cases 
the derma itself becomes very distinctly infiltrated and 
thickened. The general health is often apparently good. 
The disease is non-contagious, runs a chronic course, and 
is very prone to recurrence. 

It is customary to make certain local varieties; they 
are: 

Psoriasis capitis. — The head is one of the commonest 
seats of the disease, next to the elbows and the knees; 
the whole scalp may be affected, or there may be only 
one or two small points of eruption; when extensive, the 



248 SKIN DISEASES. 

disease travels on to the forehead, forming a kind of 
fringe along it at the upper part. There is co-existent 
disease elsewhere. The hair on the scalp thins out fre- 
quently when psoriasis attacks it. 

Psoriasis faciei. — In this local variety of psoriasis, the 
patches are often circular; they are less hypersemic, less 
thick, and less scaly than when the disease attacks other 
parts of the body, and they present consequently much 
similarity to tinea circinata, except that typical patches 
of the disease are seen in other parts of the body. 

Psoriasis palmaris ?indi psojiasis plantaris are important 
local varieties. These local varieties are infinitely rare. 
Of course, instances of so-called psoriasis palmaris and 
plantaris are common enough, but they are practically al- 
ways syphilitic. Non-syphilitic psoriasis may occur, 
though rarely, in connection with general psoriasis. But 
when such a condition exists as the sole disease, it is syph- 
ilitic and nothing else, and the concomitance of sore 
tongue and other evidences of constitutional syphilis at 
once make the diagnosis certain. The skin in the affected 
parts is generally thick, and dry, harsh, discolored; the 
scaliness is not very marked, but the superficial layers 
peel off from time to time. Presently the surface cracks 
and fissures, and healing is very tardy; occasionally the 
surface bleeds. The muscular movements of the hand 
may be painful. 

Psoriasis unguinum is mostly a complication of the in- 
veterate form of psoriasis, but it may exist alone. The 
nails (and several are usually affected) lose their polish, 
and soon become opaque, thickened, irregular, and brit- 
tle; they are then fissured and discolored in lines (from 
dirt), their matrix becoming scaly. 

Psoriasis also affects the scrotum and prepuce occasion- 
ally; the parts are swollen, red, hard, tender, scaly, fis- 



PSORIASIS. 249 

sured more or less, and give exit to a thin secretion, 
which adds to the scaUness; there are pain and pruritus; 
and the local mischief may be the sole, or part only, of 
general disease. 

Psoriatic syphilides. — Nozo asserts that psoriatic syphi- 
lides always indicate the presence of a grave variety of 
syphilis and that they occur most commonly in cachectic 
subjects. In some cases they may appear as late mani- 
festations of the disease; and their development is fa- 
vored by old age, alcoholism, congenital or acquired dry- 
ness of the skin, and perhaps, also, by gout. Cases 
occur concerning which even the most expert diagnosti- 
cian may be in doubt as to whether the eruption is the 
ordinary psoriasis or a specific eruption. 

When psoriasis is in progress of cure, the scales lessen 
and the reddened elevated surface beneath comes more 
prominently into view; but this diminishes gradually till 
the eruption disappears, leaving oftentimes no trace of its 
former presence behind. It may leave, however, pig- 
mentary stains, the result of the congestion. It is in the 
disappearance of patches of psoriasis that the centre 
rapidly clears, and the ringed form or psoriasis circinata^ 
or the lepra of old authors is produced. 

Etiology. — We possess no certain knowledge as to 
either the proximate or remote causes of the disease. It 
is not uncommon to find an extensive eruption in those 
who otherwise appear to enjoy the most robust health; 
while, on the other hand, it may appear only during 
periods of temporary debility, as in women during preg- 
nancy and lactation. That the affection is constitutional 
and connected with similar conditions to those underly- 
ing eczema we have no doubt, and each year's experience 
more strongly confirms this opinion. Some have claimed 
that the eruption is purely local or due to the presence of 
17 



250 SKIN DISEASES. 

a parasite. Positive evidence of this is wanting. Others 
pretend that it is but a relic of syphilis handed down 
from a remote ancestor. This view also has little to sup- 
port it. 

Psoriasis is often hereditary. It attacks males more 
than females, and is most common between the ages of 
fifteen and thirty. Persons of sanguineous temperament 
are most liable to the disease perhaps, and it is seen in 
persons of all classes of society, and mostly in summer 
and winter. 

Prognosis. — The disease is mostly difficult of cure 
and has a tendency to recur. The most obstinate cases 
are those of psoriasis mummularis of the back and but- 
tocks, in which there is much elevation and thickening 
and deep redness; and psoriasis about the hands and 
feet. 

Diagnosis. — In well-marked and typical cases there 
can not be the least difficulty in diagnosis, especially to 
any one who has already seen an example of the disease. 
Unfortunately, however, cases are not always typical; 
and we must learn to distinguish psoriasis from syphilis, 
eczema, and dermatitis exfoliativa. As we have already 
stated, eczema may closely resemble psoriasis. In like 
manner the latter disease may closely counterfeit the 
former in its outward appearance; and in this particular 
case the diagnosis will be by no means easy, nor arrived 
at at a glance, but only by careful consideration of the 
case in all its bearings. A squamous syphilide may 
closely resemble psoriasis; but here the history will aid 
us greatly if we bear in mind a few fundamental facts. 
In psoriatic cases of long standing we will have the his- 
tory of repeated outbreaks of eruption, but they will all 
have presented the same general type — that is to say, a 
repetition of the same kind of eruption — a squamous 



PSORIASIS. 251 

S3^philide will probably have been preceded by other 
eruptive attacks; but these have been in all probability a 
different sort of eruption — papular, pustular, or what 
not. Syphilis rarely repeats itself in its manifestations. 
If in addition we learn from the patient the prior exist- 
ence of the primary lesion, or if we find other co-exist- 
ing lesions, as alopecia, mucous patches, throat trouble, 
etc. , we should not long remain in doubt as to the nature 
of the eruption about which we have been consulted. 
The existence of squamous lesions on the palms and soles 
in connection with squamous patches on the general sur- 
face is evidence positive of syphilis. In psoriasis the 
epidermic proliferation or desquamation is much greater 
than in syphilis. We have known a case of exfoliative 
dermatitis to be mistaken for psoriasis; but if we recollect 
that the characteristic feature of the former disease is the 
exfoliation of quite extensive laminae, of not very greatly 
thickened epidermis, sometimes several square inches in 
extent, there is no excuse for mistaking the one disease 
for the other. 

Psoriasis and syphilis may of course coexist. There 
will be but little difficulty in differentiating the respective 
lesions. 

Psoriasis may coexist with eczema, both presenting 
typical lesions, or we may have lesions of mixed char- 
acter, in which it would be hard to say which disease 
predominated. Certain diseases of other organs appear 
to bear a close relationship to psoriasis. This is notably 
true of arthritic affections and also of asthma. As a rule, 
these do not coexist with the psoriasis, but manifest 
themselves during the time that the skin is free from 
eruption, alternating as it were with the cutaneous 
lesion. 

Treatment. — It is but a few years since the chief re- 



252 SKIN DISEASES. 

liance of the old school in the treatment of psoriasis was 
the internal use of arsenic and the external use of tar. 
Slow and tedious was the cure. Now, however, they 
possess an agent which they claim exhibits a remarkable 
energy in the control of the eruption. We allude to 
chrysarobin. This is employed in various ways, but the 
one seemingly most satisfactory is a mixture of thirty 
grains of the drug with one ounce of traumaticin {liquor 
gutta-percha). This should be painted on the spots 
daily until a considerable degree of local irritation is 
produced. Sedative applications should then be applied 
for a few days, and the skin allowed to recover from the 
effects of the drug. A single course of this sort will 
cause most of the spots to disappear — that is, as regards 
scale formation and infiltration — and these spots will 
usually appear distinctly white and ansemic in comparison 
with the surrounding skin, which has been darkened by 
congestion produced by the chrysarobin. Unless the 
eruption was limited both as to size and extent of the 
lesions, we will find many patches in which complete 
recovery has not taken place. These will require addi- 
tional applications. Chrysarobin possesses the incon- 
venience of staining the surrounding skin (temporarily) 
and permanently staining the clothing; and a number of 
substitutes — naphthol, resorcin, antarobin, hydroxylamin, 
etc. — have been proposed. Some of these are dangerous, 
while others are inefficient, and none of them are equal in 
efficacy to chrysarobin. This drug, however, should not 
be applied to the face or scalp, and we must instead use 
milder applications, such as tar or some of the essential 
oils, as the oleum pini sylvestris, oleum eucalypti, etc. 
The following is an excellent aid : 



9^, Chrysarobin, 

Acid Salicylici, aa gr. x. 
Unquent Resiuol, ^j. 



% 



PSORIASIS. 253 

Sig. Apply thoroughly at night and bathe thoroughly 
next morning, or, 

9^. Tar, 

Alcohol, 

Soft soap, aa Jj. M. 

Sig. Apply locally, with flannel or a coarse piece of 
cloth, and is firmly rubbed into the part night and morn- 
ing according to the effect. 

The following is a very good application for an 
ordinary case of psoriasis which is passing on to the 
chronic stage. 

^. Nitrate of mercury ointment, 3J to gjj. 
Powdered oxide of zinc, 5jj- 
Solution of lead (liquor plumbi), ^ss. 
Carbolic acid, fl. drops, jj. 
Olive oil, ^j or ^j ss. 
M. Sig. Apply nightly. 
Another excellent application is made as follows : 
^ Red precipitate, finely powdered, 
White precipitate, aa gr. vj. 

Lard, ^j. 

Mix. Sig. Apply night and morning. 
Dr. Stern recommends for psoriasis capitis : Precipit. 
alb., lo.o ; Sapon. nigr., 40.0; Lanoline anhydr., 50.0. 

M. Ft. ung., S. Rub in every evening a portion the 
size of a filbert. 

After four days all the scales are gone, and the 
affected parts become smooth and take on a natural 
appearance. It is usually advisable to continue the 
application of the lanoline alone for a time longer. 

Dr. Patterson reports a case of psoriasis of fifteen years' 
standing cured in one month by an ointment of vaseline, 
oxide of zinc and Sanitas oil. He fails to give the pro- 
portions. 

The pomade of tar is classical in the treatment of 



254 SKIN DISEASES. 

psoriasis. Axunge or oil, with one-tenth part of tar. 
The pomade of oil of cedar has been employed in the 
same proportion. The immediate action of these pomades 
is a notable amelioration of this affection. But they 
never effect a cure. 

In obstinate cases, unless the skin is very irritable, the 
oil of white birch may be used in the form of an 
ointment, one drachm to the ounce of vaseline. 

The diet in psoriasis should be a generous one, and in 
it meat ought always to play an important part. Cod 
liver oil is generally needed. 

The indications for the internal remedies are as follows: 
It is better to commence the internal treatment with 
Sulphur. Afterwards one of the following remedies may 
be given : 

Ammon. carb. — White pea-sized spots upon the cheek, 
which continually exfoliate; skin very sensitive to cold; 
aversion to being washed; nose-bleed when washing the 
face in the morning; in weak, nervous individuals. 

Arsen. alb. — Eruption red or white and scaling; skin 
dry and scaly; great restlessness with weakness and pros- 
tration, worse about midnight; burning itching; oppres- 
sion of breathing; aggravated by eating fruit, ice cream, 
etc. 

Arsen. iod. — Dry scaly burning itching eruption on 
various parts; persistent itching on the back; in obsti- 
nate cases. 

Berber, vulg. — The eruption appears with itching, 
lymphatic swellings on the articulations; must scratch 
very hard. 

Calcarea carb. — Scurfy spots on the leg; burning and 
itching; skin cracks; profuse sweat from the slightest 
exertion; large abdomen; blue eyes, blonde hair, fair 
skin. 



PSORIASIS. 255 

Clematis. — The eruption is chronic and long lasting, 
and becomes redder and more humid with the increasing, 
paler and dryer with the decreasing moon. 

Fluoric acid. — Roughness on the forehead like a rough 
line with its convexity upwards. Reddish spots above 
the eyebrows; desquamation on the eyebrows; nails 
brittle, edges bent in. 

Hydrocotyle — Circular spots with slightly raised scaly 
edges. 

Iodine. — Rough, dry and dirty 3'ellow color of the 
skin. Nervous irritation, and emaciation, with good ap- 
petite; psoriasis circinata. 

Iris vers. — Irregular psoriatic patches on the knees and 
elbows, covered w^ith shining scales; eruption becomes 
hard and dry; skin fissured and irritable; digestive de- 
rangement, with nausea, and debilit}^; starting during 
sleep; psoriasis diffusa. 

Majiganum. — In inveterate cases. 

Mercurius. — Psoriasis of the hands; psoriasis in spots 
all over the body; scaling off and exfoliation of the finger 
nails; the scalp is painful to the touch; easy perspiration 
without relief; recent cases. 

Mezej'eum. — Scurf- like scales on the back, chest, scalp 
and thighs; roughness and scaling here and there; 
pruritus increased by scratching or when undressing. 

Micriatic acid. — Psoriasis of the hands; great sensitive- 
ness to damp weather. 

Natruvi ars. — Thin whitish scales, which when re- 
moved leave the skin slightly reddened. 

Nitric acid. — Burning, itching or stabbing pains, worse 
at night, from change of weather, or during perspiration; 
strong smelling urine, like that of horses. 

Petroleum. — Skin of the hands cracked and rough; 



256 SKIN DISEASES. 

unhealthy skin; aversion to the open air; extreme sen- 
sitiveness to sHght touch; falhng off of the hair. 

Phosphorus. — Psoriasis of the arms and hands, and on 
the knees and elbov^^s; arms and hands become numb; 
brownish or bluish-red blotches, with furfuraceous dry 
scaling; coldness of the knees at night in bed; falling 
out of the hair in large bunches; dry cough, with sore- 
ness in the chest; tall, fair children, with tuberculous 
tendency. 

Phytolacca. — Surface of the skin shrunken and of a 
leaden color; squamous eruption; rheumatic pains in the 
extremities. 

Psorinum. — Eruption dry and scaling, with itching, 
weakness, and debility; after acute diseases; profuse 
colliquative sweats. 

Selenium. — Dry, scaly eruption on the palms of the 
hands, with slight itching. 

Sepia. — Psoriasis on the face; red roughness of the 
skin; falling off of the hair; during pregnancy and 
nursing; dark complexioned individuals. 

Silicea. — Elevated scurfy spots near the coccyx; small 
white scales on the face and neck; white spots on the 
cheeks; sensation of numbness in the extremities; brit- 
tleness of the nails; in scrofulous, large-bellied children. 

Tellurium. — Psoriasis annulata, eruption over the 
whole body. 

leiicrium. — Psoriasis on the index finger of the right 
hand. 



\ 



CHAPTER XII. 

DIATHETIC DISEASES. 

I shall adopt the plan as outlined by Dr. Fox, and 
include under the head of diathetic diseases the strumous, 
the syphilitic, and the leprous diseases of the skin. 
There are some objections to this classification, but they 
do not outweigh the advantages of the arrangement. 
In struma, sj^philis, and leprosy the changes in the skin 
are but a small part of the whole disease, and only 
evidence of a disposition on the part of the tissues of 
the bod}^ as a w^hole, to become changed and disor- 
dered. 

Scrofuloderma. 

This disease does not require to be dealt with very 
elaborately. "It is scrofula of the skin," and only a 
part of the general diathetic condition, w^hich is evi- 
denced by the ordinary signs of struma in greater or 
less degree of expression. As regards the skin, scrofula 
is generally characterized by the appearance at the 
outset of indolent, dull red, soft, tubercular formations, 
that rapidl}^ suppurate, and are soon covered over with 
darkish scabs, from beneath which oozes an unhealthy 
pus. Ulceration to a greater or less degree takes place, 
with the formation of exuberant granulations at times, 
and the healing is accompanied by distinct scarring. 
The whole disease is of the most chronic character. 
One can scarcely mistake the strumous ulceration for 
any other disease; it may spread and cover a large 



258 SKIN DISEASES. 

extent of surface, and in this case the ulcerated surface 
is half covered by darkish irregular crusts, whilst the 
ulcers discharge a thin disagreeable dark pus, and 
granulations are flabby and pallid, bleeding freely on 
being touched; the edges of the ulcers are livid, and 
various attempts at repair are made. The mucous 
surfaces of the nose or eye may be inflamed and slightly 
ulcerated and onychia may be present. There are old 
scars of former strumous disease, and the whole aspect 
of the patient is a sufficient tell-tale of the disease. 

The old school advises the use of cod-liver oil, iodide 
of iron, the phosphates of lime and iron, and locally an 
astringent ointment of tannin; or acetate of lead; or 
mercurial plaster; or iodide of lead ointment to the indo- 
lent ulcerated surfaces. Residence at the seaside is also 
advisable. 

These patients should be allowed an abundance of 
fresh air, plenty of outdoor exercise, and a generous 
diet. When the ulcers have formed, dress them with 
the iodide of starch paste. 

The indications for the homoeopathic remedies are: 

Alnus rubra. — Enlargement of submaxillary glands, 
strumous enlargement of tonsils; obstinate impetigo and 
porrigo, chronic diarrhoea; scrofulous disease of hip- 
joint; disease of mucous membranes, which arise from 
or alternate with eruptions of the skin. 

Arsen. zW.-— Diseases of mucous membranes, charac- 
terized by a peculiar and persistently irritating corrosive 
character of the discharges; constant susceptibility to 
take cold; excoriated nostrils and lips; swollen and cov- 
ered with scabs 

Arsen. 7net. — Great emaciation, clay-colored face, blue 
margin around the eyes; great weakness of all the limbs; 
want of disposition to do anything, and constant inclina- 



DIATHETIC DISEASES. 259 

tion to rest; lax muscles; swelling of the cervical glands; 
distended abdomen; diarrhoea; scurf}' eruptions and 
ulcers; ophthalmia; carcinoma. 

Asafcetida. — Glands hard, swollen, hot, and throbbing, 
with shooting jerking pains; soft enlargement of bones, 
with curvature; ulcers with high hard edges, sensitive to 
touch, easih' bleeding, pus profuse, greenish, thin, 
offensive, even ichorous; psoitis when suppuration 
threatens; osteitis and caries; scrofulous ozaena; hard- 
ness of hearing, with thin purulent discharge of offensive 
odor; scrofulous, bloated, clumsj^ children, with phleg- 
matic temperament. 

Asclepias tub. — Strong tendenc}^ to tubercular develop- 
ment; sharp pains in different parts of the body, with 
muscular soreness, changing from one part to another; 
impaired strength, rather feeble digestion and assimila- 
tion; glandular enlargement about neck; vesicles; pim- 
ples and pustules all over the bod}'. 

Auriwi met. — Scrofula, rudd}" complexion, light 
haired, sanguine temperament; glands painfully swollen; 
ozaena, with caries of nasal bones; fetid otorrhoea from 
caries of mastoid process; caries of cheek bones; tearing, 
boring, burning stitches in zygoma; red and swollen ton- 
sils; profound ulceration in throat. 

Badiaga. — Dandruff or dry, tetter-like appearance of 
scalp, with slight itching; scrofulous ophthalmia, with 
hardening of the Miebomian glands; tonsils red and in- 
flamed; indurated inguinal glands; glandular swellings 
on left side of face, throat, and neck, some hard, some 
suppurating; small hard lumps along tibia; flesh feels 
sore as if it had been beaten, and ver}^ sensitive to touch 
or friction of clothes. 

Baryta carb. — Physical and mental debility; atroph}^, 
great weakness; face red and abdomen bloated, glands 



260 SKIN DISEASES. 

swollen, indurated; fatty or encysted tumors; coryza, 
nose, and upper lip swollen, scurfs under the nose; 
chronic induration of tonsils; sensation as of a plug in 
throat, worse swallowing solids; crawling in rectum, ex- 
pulsion of ascarides; cannot retain the urine; chronic 
cough, with swollen glands and enlarged tonsils; worse 
after slightest cold, with soreness in chest when cough- 
ing; chronic torticollis; pimples, ringworms, humid 
sores. 

Bellad. — Hard, swollen, and ulcerated glands; muscu- 
lar debility, with difficulty of learning to walk; photo- 
phobia, inflammation of eyes and eyelids; cough, with 
mucous rales; otorrhoea; emaciation and atrophy; ulcers; 
inflammatory swelling of nose and lips; frequent epistaxis; 
frequent sore throat, with swelling; distended and hard 
abdomen; enuresis day and night; premature develop- 
ment of mind; blue eyes and blonde hair. 

Berberis aquifol. — This remedy is highly recommended 
by several physicians. Dr. Mallery uses the following 
prescription : 

9^, Fluid ext. berberis, 

Syrup simplex, aa ,^iv. 
M. S. Teaspoonful every four hours. 

Bromium. — Swelling and induration of the glands; en- 
largement of thyroid, in children with Hght hair, blue 
eyes, and fair skin; pimples and pustules; boils on the 
arms and face; hard swelling of left parotid, edges 
of opening smooth, discharge watery and excoriating, 
swelling remaining hard and unyielding; tonsiUitis; swal- 
lowing of fluids more difficult than of solids; hard uneven 
tumor in right mammae, firmly adherent to its surround- 
ings, with lancinating pains, worse at night; stiffness of 
neck. 

Calcarea carb. — Malassimilatioii; tardy developmejit of 



DIATHETIC DISEASES. 261 

bony tissue; large head with open fontanels; curvature of 
the back and vertebrae or other rickitic affections; herpes, 
tinea, crusta lactea; hard or suppurating glandular swell- 
ings; ulcers, exostosis, or caries; hard and enlarged 
abdomen, with swelling of mesenteric glands; emaciation 
and voracious appetite; thirst constant, even after drink- 
ing; profuse perspiration of head; thin and wrinkled 
face, with dim eyes; dry and flaccid skin; difiQculty of 
learning to walk; difficult dentition; red swelling of 
nose; bronchocele; swelling of upper lip; frequent bleed- 
ing of nose; feet cold and damp; craves eggs. 

Calcarea iod. — Tendency to alternate diarrhoea and 
constipation; no thirst; pustular eruption, sore and pain- 
ful, with desire to rub and scratch it, though it makes it 
worse; abdomen enlarged, breath offensive; cold sticky 
perspiration, feet cold and damp; restless, fretful, and 
irritable; pus from abscesses thin and ichorous; granular 
inflammation of membrana tympani; scrofulous oph- 
thalmia. 

Calcarea phos. — Emaciation, dirty- white or brownish 
complexion; skull soft, thin, crepitating when pressed, 
especially in occiput; craves bacon, salt meat, and potatoes; 
swelling of the epiphyses, difficult teething, slow closing 
of the fontanels; curvature of spine to the left, lumbar 
vertebrae bent forward; abscesses near lumbar vertebrae; 
incipient mesenteric tabes, with much fetid diarrhoea. 
Tendency to tuberculosis. 

Chimaphila. — Glandular enlargement, especially of 
lymphatics; enlargement of mesenteric glands; ulcers of 
an indolent and flabby character ; tumors in mammae. 

Cina. — Child feels uneasy and distressed, does not 
want to be touched, is not pleased or satisfied with 
anything, leaves his head side-ways all the time, rubs 
nose constantl}^ ; pale sickly-looking face ; hunger and 



262 SKIN DISEASES. 

thirst soon after eating, with gnawing sensation in 
stomach ; abdomen hard and distended ; itching at anus; 
ulcers with scanty discharge ; inability to retain urine. 

Cistus Can. — Glands swollen, inflamed, indurated, or 
ulcerated; drawing tearing pains in all joints; itching 
all over the body, without eruption; herpetic erruption of 
various parts; chronic scrofulous ophthalmia, feeling as if 
something was passing around in the eye, with stitches; 
watery, bad-smelling pus discharged from ears; tetters on 
and around ears; swelling of parotids; eczema of nose; 
caries of lower jaw, with suppurating glands in neck; 
cool feeling in stomach and abdomen; cool eructations; 
chronic diarrhoea; swelling and suppuration of glands of 
throat; scrofulous ulcers on back; desire for acids and 
acid fruit, but they cause pain and diarrhoea. 

Conium. — Swelling of glands, with tingling and 
stitches; marasmus with frequent sour belching, worse 
during night; erratic itching of all parts of body; humid, 
burning, corroding, crusty herpes; blackish ulcers, with 
bloody, fetid, ichorous discharges, especially after con- 
tusions; ophthalmia with photophobia; blenorrhoea 
bronchialis; asthma; carcinoma. 

Cory dalis form. — Scrofulous cutaneous diseases, accom- 
panied by feeble digestion and poverty of blood; scrofu- 
lous syphilitic diseases. 

Cornus circin. — Scrofulous ophthalmia, herpes of eye- 
lids; ulcerations of tongue, gums, and mouth. 

Graphites. — Swelling and induration of glands; eczema 
capitis of entire scalp, forming massive dirty crusts, 
which mat the hair together; eczema beginning as a 
moisture behind left ear, and spreading over cheeks and 
neck; thick, yellowish, fetid discharge from nose; dry 
scabs in nose, with sore, cracked, and ulcerated nostrils; 
painful nodules on lower jaw; chronic catarrhs of 



DIATHETIC DLSEASES. 263 

stomach and bowels; glandular swelling in groins; 
fissures and rhagades; turbid urine; unpainful swollen 
glands on nape of neck. 

Hecla lava. — Scrofulous ostitis or periostitis, resting on 
a syphilitic basis, and especially affecting the bones of 
face and of antrum highmori; difficult dentition; rachit- 
is; hip disease; white swelling; induration and infiltra- 
tion of cervical glands, studding the neck like a row of 
pearls; toothache from swelling about the jaws; abscesses 
of gums from decayed teeth. 

Hepar. — Glands inflame, swell, and suppurate; hard 
burning nodosities; unhealthy skin: slight injuries sup- 
purate; stinging burning of edges of ulcers, discharging 
bloody pus; humid eruption of fetid odor, feeling sore, 
itching violently; nodosities on head, relieved by cover- 
ing the head warmly and from sweat; discharge of fetid 
pus from ears; boils on face, lips, and chin; cancerous 
ulcers; disposition to phlegmonous sore throat, catarrh, 
or bronchitis; atrophy. 

Hydrastis. — Chronic catarrhs of mucous membranes 
wherever situated; cancerous cachexia; cancers hard, 
adherent; skin mottled; puckered, with lancinating 
cutting pains; atony of muscles. 

Hypophosphite of Lime — One of the best remedies we 
have for so-called scrofulous manifestations. It fully 
answers Hahnemann's indications for the use of Calc. 
carb. in scrofulous affections, especially when occurring 
in children, namely, the overgrowth, the large head and 
open fontanels, the distended abdomen, the tendency to 
swelling of lymphatic glands, the tendency to brain 
affections, to catarrhal discharges, abscesses, etc. 

lodum. — Emaciation, in spite of the necessity of eating 
every few hours; swelling and induration of glands, the 
whole of the lymphatic system being involved; swelling 



264 SKIN DISEASES. 

of mesenteric glands; bronchocele; scrofulous women, 
with dwindling and falling away of the mammae. 

Kali bichr. — Scrofulous ulcers and skin diseases; dis- 
charges from mucous membranes tough, stringy, sticking 
to the parts; caries of the bones of the nose; strumous 
ophthalmia; pustular diseases of skin, secreting a watery 
fluid when broken or drying up into a yellow tough mass; 
fat, chubby children; fat, light- haired persons. 

Kali hydroiod. — It distends all tissues by interstitial 
infiltration; enlarged glands; tophi; exostosis; swelling 
of bones; necrosis; all worse at night; bronchial and 
submaxillary glands swollen, ulcerating, atrophied; 
goitre; papules on face, back; small boils on face, head, 
neck, back, and chest, leaving scars; pustules on cornea, 
without photophobia, redness, or pain. 

Lithium carb. — Skin rough as a grater, harsh, dry; 
dry itching eruption like ringworms; milk crust; whole 
body, bones, joints, muscles, sore as if beaten. 

Lycopodium. — Swelling and suppuration of glands; 
herpes and ulcers; humid suppurating eruptions, full of 
deep rhagades, breeding lice, itching violently; inter- 
trigo; raw places, readily bleeding; boils which do not 
mature, but remain blue; scalp covered with scabs; 
chronic enlargement of tonsils. 

Lapis albus. — Scrofulous affections, abscesses, and 
sores; enlargement and induration of glands, especially 
cervical; glandular tumors, where physiologically no 
glands are usually found; goitre; cretinism. 

Mercurius. — Glandular swellings, with or without sup- 
puration; cachectic affections; exostosis, curvature, 
caries, and other affections of bones; eruptions and 
corrosive herpes with crusts; tinea capitis; crusts in the 
face; suppuration, especially if too profuse; ulceration of 
tonsils. 



DIATHETIC DISEASES. 265 

Mercurius biniod. — This is one of our best remedies. 
It is especially in the relief of those tardy engorgements 
and ulcerations which follow the discharge of the soft- 
ened scrofulous matter. It may be given during the 
growth or swelling of the gland with the hope of disper- 
sion, as we cannot always surely know whether the en- 
largement is attributable to the presence of scrofulous 
matter or to simple congestion and engorgement. 

Natrum carb. — Swelling and induration of glands; 
emaciation, with pale face, dilated pupils, dark urine; 
skin dry, rough, and chapped; suppurating herpes, with 
yellow rings; goitre; swollen cervical glands; humid 
herpetic eruptions and ulcers on nose, lips, and around 
mouth; burning fissures on lower lips. 

Oleum jec. ars. — Only indicated inpatients of a slender 
and lean figure, thin, transparent skin, with a frequent 
pulse, great excitability of the nervous system, and high 
specific gravity of the urine — all signs of an accelerated 
metamorphosis. 

Petroleum. — Swelling and induration of glands; un- 
healthy skin; small wounds ulcerate and spread; polypi; 
salt rheum on arms and hands, red, raw, burning, moist, 
or covered with thick crusts; herpes on knees and 
ankles. 

Phytolacca. — Swollen tonsils; indurated glands; glands 
and bones inflamed and swollen. 

Psorinum. — Pale, sickly, delicate children, whose body 
always has a filthy smell, even after a bath; deeply pene- 
trating, ichorous ulcers; skin dirty, greasy-looking, with 
yellow blotches here and there, at times itching; scratch- 
ing gives temporary relief; hair dry, lustreless, tangles 
easily; pustules and boils on head; scalp looks dirty and 
emits an offensive odor; wants to have the head covered 

i8 



266 SKIN DISEASES. 

even in hot weather; purulent offensive otorrhcea; sub- 
maxillary and lingual glands swollen, sore to touch. 

Rhus tox. — Swelling of glands; herpes in the face and 
other eruptions discharging pus or forming crusts; emaci- 
ation; hard and distended abdomen. 

Sarsaparilla. — Great emaciation, skin shrivelled or lies 
in folds; herpetic circular ulcers, forming no crusts, red 
granulated bases, white borders; deep burning rhagades; 
milk-crust; ophthalmia after checked tetters; marasmus 
of childreji; neck emaciated, 

Silicea. — Swelling and suppuration of glands; exos- 
tosis; curvature, and caries of bones; pale and bloated; 
disposition of skin to ulcerate; eczema, impetigo, herpes; 
tendency to boils, which leave indurations; carbuncles; 
malignant pustule; blepharitis; otorrhoea; canine hunger, 
with nervous irritable persons; desires only cold things; 
swelling and induration of cervical glands and parotitis; 
imperfect ?i2itrUion, not from want of food, but from imper- 
fect assimilatio7i. 

Spongia. — Swelling and induration of glands; skin 
and muscles lax; light hair; fevers; yellow scabby erup- 
tion; suppuration of external ear; insatiable appetite 
and thirst. 

Sulphur. — Scrofulous and rickety complaints; emacia- 
tion of children, face has a very old look; dry flabby 
skin; glandular swellings, indurating and suppurating; 
ulcers, with raised swollen edges, bleeding easily, dis- 
charging fetid pus, surrounded with pimples; humid of- 
fensive eruptions, with thick pus, yellow crusts, itching, 
bleeding, and burning; ophthalmia and blepharitis; puru- 
lent offensive otorrhcea; painful eruptions around chin; 
lips dry, rough, and cracked; curvature of spine from 
softening of vertebrae; hangnails; burning of soles, wants 




im 



Syphiloderma Pustulosum. 



DIATHETIC DISEASES. 267 

them uncovered; children dislike being bathed; especially- 
suitable for lean stoop-shouldered persons. 

Theridi07i. — Scrofula, rachitis, caries, necrosis, when 
other remedies fail to reach the root of the evil, and 
destroy cause; itching on scalp; itching behind ears, 
she would like to scratch them off; chronic catarrh of 
nose, discharge offensive, thick yellow or yellowish- 
green; phthisis florida, in beginning. 

Syphilis. 

Syphilis is a disease that involves, not only the skin, 
but every other organ and tissue of the body. Its 
cutaneous relations, however, are those which chiefly 
concern us. 

The first visible lesion of syphilis usually appears in 
from ten to twenty days after an infective intercourse, as 
a small papule or erosion, going on to ulceration, and 
most frequently situated on the genital organs. Extra- 
genital chancre, however, may be met with in a variety 
of locations, more frequently, perhaps, about the mouth 
than elsewhere. This lesion is termed a chancre. In 
a short time a limited induration of the subjacent tissue 
occurs, so that the chancre when taken between the 
fingers appears to have a hardened base. This indura- 
tion may be, and frequently is, absent in genital chan- 
cres in women, and the lesion may be altogether over- 
looked. In the course of two or three weeks after the 
appearance of the chancre certain of the lymphatic glands 
become involved, and take on enlargement and hardness. 
The glands chiefly noticeable in this respect are the 
inguinal, cubital, post-cervical, and post-auricular. 

About this time, or a little later, we may expect a 
generalized outbreak upon the skin. 

The various manifestations of syphilis on the skin, or 



268 SKIN DISEASES. 

syphilides, as they are commonly called, present different 
types and degrees of severity, and involve the skin either 
superjScially or deeply. We may, however, classify them 
to a certain extent, and in doing so will find that they 
partake of one or the other of the following characters, 
namely : macular, papular, tubercular, pustular, squa- 
mous, bullous, and gummatous, together with ulcera- 
tion, occurring with, or following, any of the five types 
last mentioned. 

The appearance of the first cutaneous eruption ushers 
in what is termed the secondary period of the disease. 

As a rule, the first eruption is macular, and consists 
of small, rosy points or spots usually called syphilitic 
roseola. These present little or no elevation, and disap- 
pear under pressure, showing that they are little more 
than points of congestion. They usually pass away 
within a few weeks, with or without treatment. They 
are chiefly met with on the trunk and extremities. 

Another and much rarer macular lesion is the pigmen- 
tary syphilide, which appears as dark-colored spots on the 
neck, and almost w^holly confined to j^oung females. After 
a time a portion of the pigmentary deposit fades away, 
producing a somewhat characteristic appearance some- 
what resembling vitiligo. 

After the macules of syphilis have disappeared, or 
even before they are quite gone, a generalized eruption 
of papules may appear. These are solid elevations, and 
not unfrequently present minute scales at their apices. 
Should the patient be broken in health, a tendency to 
pustulation and ulceration may be developed; and we 
may have the papules becoming purulent at their sum- 
mits, or we may have a frankly pustular eruption from 
the outset. As the disease progresses there is a tendency 
to deeper involvement of the integument and larger size 



DIATHETIC DISEASES. 269 

of the lesions, so the papules are not uncommonly fol- 
lowed by tubercles, not perhaps as numerous as the 
papules, but still freely distributed over the entire sur- 
face. These not infrequently undergo ulceration and 
become covered with greenish-black crust. 

In addition to the foregoing, we may have the appear- 
ance of reddish and not greatly elevated patches, covered 
with white scabs, constituting the so-called squamous 
syphilide. These various manifestations may occupy 
a year or more in their evolution, and embrace the 
secondary period of the disease. After the disappearance 
of these various eruptions, there is not infrequently a de- 
cided halt in the progress of the disease, and the patient 
may go on for a considerable period, for years even, 
without a fresh outbreak. When it does come, however, 
it ushers in what is known as the tertiary stage of the 
disease. 

In the tertiary period of syphilis the eruptions are 
usually of a tubercular or ulcerative character, and, in- 
stead of being generally and somewhat evenly distributed 
over the surface, they are usually collected into groups; 
for instance, half a dozen or more tubercles may form a 
group or patch, and there may be one or several such 
patches. As a rule, the number of patches is limited. 
The individual lesions sometimes disappear b}^ absorption, 
but very frequently undergo ulceration, and in either 
case leave indelible scars. In this stage of syphilis we 
meet with the lesion known as the gumma. It consists 
of a small tumor, which usually undergoes softening 
throughout its entire substance, and terminates by ulcera- 
tion. This lesion is not confined to the skin, but niay in- 
volve almost any organ of the body. 

Concomitants of Syphilis. — The disease we are describ- 
ing does not vent its entire energy upon the skin, but 



270 SKIN DISEASES. 

early in its history it exhibits its presence on the mucous 
membranes by the development of rather large, flattish 
tubercles in the mouth and about the genital organs and 
around the anus. It is in females especially that the 
mucous patch or condyloma reaches its highest develop- 
ment. 

Early in the disease, too, the hair may fall out, so that 
an almost complete alopecia of the scalp may occur be- 
fore it is checked by treatment. This early alopecia, 
however, is not permanent, as the hair begins to grow 
again as soon as the patient is brought under the in- 
fluence of proper constitutional treatment. During this 
period, also, inflammation of the iris is a not infrequent 
complication. 

Ulcerations, more or less extensive, of the soft palate 
and tonsils, may supervene among the early or late 
symptoms of the disease. 

In the tertiary period painful swellings are met with 
along the course of the long bones, especially the tibia 
and in the flat bones of the skull. These nodes, as they 
are called, are due to an inflammatory deposit beneath 
the periosteum, which is usually accompanied with con- 
siderable pain, worse at night. The gummy deposit, 
separates the periosteum from the bone, and, by depriv- 
ing the bone-tissue of its proper nourishment, produces 
necrosis. 

An interesting case is reported of ulcerating gummata 
of the scalp forty-four years after infection, as occurring 
in a man aged 63, who contracted syphilis when between 
eighteen and twenty years of age. Typical syphilides 
followed, relapsed a number of times and finally disap- 
peared without treatment. When he was twenty-four 
years old (about five years after infection) he married. 
His wife miscarried once, but remained healthy, dying 



DIATHETIC DISEASES. 271 

at sixty. His eldest son developed psoriasis palmaris 
when seven yearsold and again when eighteen, which was 
caused by anti-syphilitic treatment; in other respects, as 
well as his younger sister, remained well. The patient 
himself was affected by herpes zoster in 1878. In 1886 a 
gumma appeared on the left parietal bone, which 
ulcerated and exposed the bone and caused necrosis. 
Gradually the bone was cast off, and necrosis of the 
•diploe appeared. As, however, demarcation proceeded 
slowly and symptoms of pressure on the brain set in, 
trephining was decided upon, which exposed a collection 
•of pus under the necrosed bone. Improvement set in on 
anti-syphilitic remedies. Soon, however, an attack oc- 
curred during which he lost consciousness; then the 
functions of the brain becam^e disturbed, intelligence 
gradually waned, oedema of the extremities set in, new 
gummata appeared on the scalp, and the patient died. 
Post-mortem there were found thrombosis of the iliacs, 
caries and necrosis of the left parietal bone, thickening 
of the meninges, beneath it, but no pathological changes 
in the brain. 

The ulcerations of syphilis are somewhat peculiar, and, 
once seen, can hardly be mistaken afterward. The}^ are 
usually round, and with clean-cut margins, as if punched 
out, differing in this respect from the overhanging walls 
of scrofulous ulcers, or the sloping margins of the simple 
variety. 

Late in the disease, and among the tertiary group of 
symptoms, w^e meet with a peculiar deformity of the 
phalanges, commonly known as dactylitis syphilitica^ the 
appearance of which is so peculiar and characteristic that 
it should not be mistaken for anything else. This lesion 
is rare, however, and perhaps unknown to man}^ physi- 



272 SKIN DISEASES. 

cians, and the illustration best shows its characteristic 
features. 

Necrosis of the nasal and palatal bones may occur late 
in the disease. 

Syphilis is an all-pervading disease, and may involve 
the viscera as well as the more superficial organs The 
liver, kidneys, lungs, brain, spinal cord, etc., may be- 
come the seat of gummy tumors, which, according ta 
their location and size, may do more or less damage^ 
even to the extinction of life. 

Dr. Marchiafava thus describes the lesions found by 
him in the kidney in two cases of hereditary syphilis r 
" The organs were of normal size, but the cortical sub- 
stance was of a grayish color, and dotted with minute 
whitish nodules, corresponding to the glomeruli. Under 
the microscope, the lesions w^ere seen to proceed from a 
diffuse arteritis of the glomerular and afferent vessels. 
The arteries were contracted, and finally obliterated, and 
became converted into a hyaline mass The vascular 
loops of the glomeruli were thus destroyed, as was also,, 
at a later period, the epithelium of the convoluted 
tubules which derives its nourishment from the afferent 
vessels. ' ' 

Dr. Ingram has observed, in twelve cases of congenital 
syphilis, concentric enlargement of the wrists. This en- 
largement has more the appearance as if two fine silk 
ligatures had been tied around the wrist immediately 
above the joint, the strands being placed about half an 
inch apart and tied tight enough to hide themselves in 
the flesh. To the touch they have all the dense hard 
feeling that callus does when thrown about a fracture. 

Etiology. — The original first cause of syphilis is un- 
known. We know, however, that at the present time it 
is propagated from one to the other by contact. The 



DIATHETIC DISEASES. 273 

blood and the secretions from early syphilitic lesions are 
the medium of contagion, and the contact of these with 
an abrasion of the skin or with an even unabraded 
mucous surface is sufficient to transfer the disease. 
Whether a bacillus is an accidental or an essential feature 
of the process may as yet be considered unsettled. 

In the vast majority of instances syphilis is contracted 
during sexual intercourse; occasionally, however, the 
buccal cavity is made to serve the ordinary purposes of 
the vagina, and the disease is transferred from or to the 
mouth. There are, however, many innocent wslys of 
contracting the disease; for instance, using drinking- 
glasses, cups, spoons, pipes, etc., which have been 
previously used by a syphlitic, etc. 

Sternback reports a severe attack of syphilis in an 
army surgeon, acquired in a peculiar manner. While 
attending a case of blenorrhoea of the eye he was at- 
tacked by the same disease and had leeches applied ta 
the temple to combat the acute inflammatory sj^mptoms. 
One of the leech-bites became the site of the initial 
sclerosis of syphilis, to be followed later by the usual 
secondary manisfestations. After bix months iritis de- 
veloped, and shortly afterwards svmptoms of severe 
cerebral syphilis. How the leech-bite was infected by 
the syphilitic virus is unexplainable. 

It is altogether probable, however, that in tertiary 
S3^philis, especially if a considerable number of years 
have elapsed since the first contraction of the disease^ 
neither the blood nor secretions are contagious. 

Syphilis may also result from hereditary transmission. 
Should the father alone be syphilitic, the offspring 
usually escapes; but if the mother be affected, the child 
will almost certainly suffer. In the majority of cases, 
when infection of the mother occurred but a short time 



274 SKIN DISEASES. 

before conception, the foetus will die in utero, and be ex- 
pelled before time. A second or third abortion may suc- 
ceed, but ultimately the mother may give birth to a liv- 
ing child, which, however, may soon succumb to the 
disease. As the period of time from the date of infection 
becomes greater, the less does the poison affect the off- 
spring, until a time arrives when the offspring of parents 
who have both been previously syphilitic may be born 
without apparent taint and grow up healthy children, 
reaching adult life without mishap. The symptoms of 
hereditary syphilis may be manifested shortly after birth 
by erythematous blotches, bullae, coryza, and marasmus, 
or may be deferred until about the period of puberty. In 
this event, interstitial keratitis, or various ulcerations, 
may be the chief features presented by the disease. 

An interesting case was reported in 1889 of a child 
four months of age, whose parents had acquired syphilis 
fourteen years before. Though anti-syphilitic treatment 
had been insufficient, their syphilis ran a very mild 
course, and they experienced very few syphilitic 
manifestations. Their first child, born three years after 
their marriage, died from meningitis at the age of seven 
years; the second had a syphilitic eruption at the end of 
the second month; the third succumbed to cholera 
infantum; the fourth died in its first month, of broncho- 
pneumonia; the fifth had an interstitial keratitis three 
days after its birth. This, the sixth child, showed an 
extensively distributed papular syphilide. At the time 
of conception, the parents did not show any syphilitic 
symptoms. Other cases have been met with of syphilitic 
infection from parents to children even twenty years after 
the primary infection in the parent. 

Dr. Mackenzie gives the history of a case of congenital 
syphilis in which ulceration of the throat was a marked 



DIATHETIC DISEASES. 275 

phenomenon. This progressed in spite of the remedies 
employed to check it, until the child was taken with a 
mild form of scarlatina, when the ulceration at once 
"began to heal. When the stage of desquamation was 
reached, cicatrization was complete. In his remarks on 
the case, which is but typical of a class, he says that 
frequently specific ulcerations in children stubbornly 
refuse to cicatrize. Under such circumstances when 
remedial measures are apparently of little or no avail, 
thej^ sometimes cicatrize, as if by magic, on the accession 
of an acute disease. While congenital syphilis affords no 
absolute protection against certain acute infectious 
diseases, its existence in the individual seems often, 
other things being equal, to mitigate their severity and 
exert a favorable influence on their course. Certain 
acute diseases, accompanied by an exanthem, favor the 
dissipation, at least temporarily, of the throat and other 
manifestations of syphilis. While at no period of the 
disease is the child exempt from these affections, they are 
more liable to be contracted during the period of latency, 
that curious interval of apparent health in congenital 
syphilis, which Cazenave has poetically called the sleep 
of the virus. These remarks are limited to scarlet fever, 
measles and chicken-pox, but they could doubtless be ex- 
tended to embrace others of the exanthemata; or, in 
other words, to those diseases which present a certain 
analogical resemblance to syphilis. They do not apply, 
for obvious reasons, in the case of excessive virulence of 
the syphitilic cachexia or malignant epidemic influence of 
the inter-current disease. Of special interest is the effect 
produced by acute febrile disease upon the throat lesions 
of congenital syphilis. Chronic inflammatory conditions 
and ulceration of the larynx, pharynx, and nasal passages 
are often influenced in a remarkable manner through the 



276 SKIN DISEAvSES. 

presence in the individual of an inter-current febrile 
affection. This is, moreover, eminently true of those 
acute blood diseases with special tendency to local mani- 
festations in the throat, such as scarlet fever, measles, 
diphtheria, etc. According to personal experience, 
scarlatina and measles exert, as a rule, a favorable 
influence on the course of the throat affection, their sup- 
ervention being of itself sufficient to cause its complete 
disappearance. The poisons of the two diseases, in their 
circulation in these regions, appear to be mutally destruc- 
tive and the throat escapes by virtue of such reciprocal 
antagonism. The cure here may be permanent, or 
relapses of the inflammatory or ulcerative process may 
follow the removal of the antagonistic influence of the 
inter-current disease. These remarks do not apply to 
diphtheria. When this affection supervenes during the 
existence of lesions in the throat, the patients rapidly 
succumb to the disease. The existence of syphilis in the 
child apparently increases the tendency to membranous 
formation; indeed in some instances, apart from the 
presence of the diphtheritic process, there seems to be a 
special tendency to fibrinous formation in the nose and 
retronasal space. 

Diagnosis. — To commence at the beginning, the 
initial lesion or chancre is to be distinguished from the 
soft venereal ulcer (chancroid) by its long (two or three 
weeks) incubation, its plastic character, its indurated 
base and its slight tendency to secretion, and the single 
or very limited number of lesions. 

The soft chancre, on the other hand, appears a few 
days after intercourse, presents a necrobiotic or ulcerative 
character, is not accompanied with the hard, infiltrated 
base, and may exist to the number of a dozen or more on 
the same patient. 



DIATHETIC DISEASES. 277 

In syphilis the initial lesion is usually accompanied 
with a number of moderately enlarged hard inguinal 
glands, while the chancroid may be accompanied with 
one or more very much enlarged and greatly inflamed 
and painful glands, which not infrequently go on to sup- 
puration. In addition, we have in syphilis the other 
glandular indurations already noticed. 

There are very few cases in which the earlier syphilitic 
eruptions cause any great trouble in diagnosis. Taking 
the history into consideration, neither the macular nor 
tubercular eruptions are liable to be mistaken for anything 
else. The papular eruption of lichen planus, however, 
may sometimes closel}^ resemble a syphilide. The 
squamous syphilide may in like manner be mistaken for 
ordinary psoriasis. In most cases, however, we will 
learn (if the case is psoriasis) that the patient has had 
previous attacks of the same form of eruptions, while in 
syphilis the previous eruptions will have been of a 
different type. 

In late syphilis a patch of tubercular lesions may be 
mistaken" for lupus. The history, however, again helps 
us, for a lupus patch will have been many months, per- 
haps years, in forming, while the syphilitic lesions 
might have reached the same development in a few weeks. 

The real difficulties that surround the diagnosis of 
syphilitic eruption, however, do not so often occur in 
simple, uncomplicated cases as in those where a syphilide 
coexists with some other eruptive affection. Thus we 
have seen at the same time a syphilide and an eczema, a 
syphilide and a psoriasis, a syphilide and leprosy, a 
syphilide and scabies, etc., and each of these separate 
eruptions pursued its own course apparently unmodified 
by the presence of the other. 

Treatment. — In former times it was a question 



278 SKIN DISEASES. 

whether the disease or its treatment caused the greater 
inconvenience or suffering to the patient. 

The treatment of a given case of syphilis will, of course, 
depend on the stage of the disease and the condition of 
the patient; but if the case comes at the beginning — that 
is, during the period of the chancre — the early or sub- 
sequent treatment ma}^ be pretty clearly mapped out in 
advance. 

When a patient presents a venereal sore, the question 
of diagnosis must be settled at the outset, and settled in 
the most definite manner prior to the institution of a 
direct anti-syphilitic treatment. If the diagnosis cannot 
be made with absolute certainty, defer the specific treat- 
ment until the secondary eruption appears. Granting, 
however, that the diagnosis of syphilitic chancre has 
been made, let us first consider what shall not be 
done. Some have fancied that they could produce an 
abortion of the syphilis by early destruction of the 
initial lesions; and, to this end, the chancre was ex- 
cised or cauterized. Experience shows that this hope 
can not be reahzed. Neither excision nor cauterization, 
no matter bow early they are practiced, will prevent the 
further development of the disease, while they do add 
very materially to the discomfort of the patient. What, 
then, shall be done? There is but one drug, so far as 
known, that is positively and directly curative in this dis- 
ease — namely, mercury; and the sooner the patient is 
brought under its influence the better. The two schools 
employ it in different ways. We will first look at the 
method employed by the old school, and afterwards the 
method as employed by the new school. An eminent 
writer of the old school, in speaking of the treatment of 
syphilis, uses the following language: 

" My own practice is to use this agent (mercury) both 



DIATHETIC DISEASES. 279 

internally and externally, believing as I do that the drug 
acts by virtue of its particles being brought into direct 
contact with the lesions, externally by means of lotions, 
salves, or other applications, internally through the 
medium of the blood and circulation. To the chancre, 
then, we may make a mercurial application, and the old 
black wash answers admirably, except that it should con- 
tain about four times as much calomel as the officinal 
preparation allows. This should be applied two or three 
times daily. At the same time mercury should be given 
internally. Before commencing treatment, however, it 
is m}^ custom to have a distinct understanding with 
the patient on two points —namely, the use of tobacco 
and alcohol. If the patient is in a fair state of general 
health, and will consent to the absolute abandonment of 
these two substances, it will not be going too far to promise 
him a very easy time in connection with his disease, pro- 
vided, of course, that he pursues the direct medical treat- 
ment with persistence and regularity. 

" The choice of the mercurial preparation to be given 
is not a matter of indifference. During the early period 
of the disease — say, for the first six months or a year — 
metallic mercury or the protosalts are to be preferred to 
persalts. Later the persalts seem to be more useful. 
Metallic mercury, either in the form of blue-pill or in 
trituration, may be given, so that the patient receives a 
half-grain of the metal three or four times a day. The 
dose, however, should be pushed until the patient is on 
the verge of salivation, but never in the slightest degree 
beyond this. When this point is reached, we have a 
guide to the patient's tolerance of the drug, and omission 
of treatment for a day or two is recommended. It should 
then be resumed in somewhat smaller doses, and, with 
the gums and salivary glands for a guide and warning, 



280 SKIN DISEASES. 

the drug should be administered with scrupulous regu- 
larity for weeks and months. In former times salivation 
was considered the sheet-anchor of safety. Now, we 
know that it is a danger to be avoided. Under this 
treatment many a patient will go on for a j^ear or more 
with only the slightest inconveniences from his disease. 
Instead of metallic mercury, the protoiodide may be em- 
ployed; and this, indeed, is the favorite with most vene- 
real surgeons. After this period, if all has gone well, 
I prefer to give either the bichloride or the biniodide. 
Some cases, however, will not go well, and, instead of 
superficial and not very serious eruptions, we find a 
tendency to ulceration developing quite early. This 
opens the gate for another drug — namely, the iodide of 
potassium. There are physicians who appear to be afraid 
of mercury, and who, believing the iodide to be compara- 
tively a benign and innocent drug, give it in even the 
earliest stages of the disease. Personally I regard the 
earl}^ administration of this drug as harmful. The iodide 
of potassium, in the writer's judgment, does not exert the 
slightest curative influence on the disease itself, or tend 
in the slightest degree to eradicate it from the system. 
It does, however, possess a wonderful power over certain 
manifestations of the disease. In syphilitic ulcerations, 
in gummatous lesions, and in periostitis, the effects of 
the iodide are not only positive but marvelous. Pe? 
contra^ in early superficial lesions and in late necrotic af- 
fections of the bones, it is not only useless but harmful. 
In syphilis we have two types of ulceration. In one the 
process is sluggish, and in the other active and rapid in 
its destructive effects. In both of these the iodide should 
be employed. In the former it should be given in small 
doses —say, five to ten grains three times a day— and com- 
bined with small doses of either the bichloride or binio- 



ii 



DIATHETIC DISEASES. 281 

dide; while in the rapidly destructive forms of ulceration 
the mercury should be omitted, and the iodide given in 
full and increasing doses. 

" As soon, however, as the particular lesions for which 
the iodide is given are brought under subjection, the 
drug should be given in diminished doses and soon dis- 
continued, and mercury in small doses substituted for it. 
* ' In the sluggish ulcerations of cutaneous syphilis 
there is no question as to the benefit to be derived from 
local mercurial applications, and a favorite with the 
writer is fifteen grains of the protoiodide to an ounce of 
simple ointment. 

" Instead of administering mercury by the mouth, it 
may be used in the form of blue ointment rubbed into the 
groin or axilla. Or it may be given in hypodermic injec- 
tion, employing either a soluble or an insoluble prepara- 
tion. There are, doubtless, occasional cases in which 
these methods may be preferred; but as habitual or 
routine methods of treatment they are mentioned only to 
be condemned. 

" There remains one drug, however, that is useful in 
certain syphilitic conditions, but of which very little 
mention is made in modern text-books. I allude to gold. 
In necrosis of the bones, especially the nasal and pala- 
tine, gold unquestionably hastens the separation of the 
sequestrum by promptly determining the line of demark- 
ation between the healthy and the diseased tissues. A 
grain of the chloride of gold and sodium may be dis- 
solved in an ounce of water, and five to ten drops be 
given once or twice a day. No advantage, we believe, 
will be derived from increasing this dose. It should be 
continued for a short time after the separation and re- 

I moval of the bone, as it seems to decidedly promote the 

I healing process." 

; 19 



282 SKIN DISEASES. 

In contrast with this heroic treatment comes the recom- 
mendation of Hahnemann to use Mercurius vivus in the 
30X potency, one dose of which will usually be suflScient 
to establish a cure. 

Later, we will give the indications for the homoeo- 
pathic remedies indicated in the different forms of 
syphilis. 

Just here I wish to call attention to the mechanical 
treatment of the syphilitic affection of the tongue and 
mouth known as keratosis or ichthyosis linguae, or as 
leukoplakia specifica, which is due to unequal develop- 
ment of epithelium over different papillae, and which is 
by no means a very easy affection to treat successfully, 
caustic, astringent, and disinfecting applications hav- 
ing but little effect upon it; according to Dr. Horwitz, it 
is best managed by mechanical scraping. He uses a 
sharp spoon, with which he removes the thickened 
epithelium; in order to accomplish this, several sittings 
may be required. He scrapes away the indurated tissue 
until the surface presents the appearance of a multitude 
of minute-bleeding points, showing that the vascular 
loops in the papillae of the dermis have been reached, 
lodo- glycerine, glycerine of borax or a ten per cent, 
solution of sulphate of copper is applied to the raw sur- 
face. The pain is usually not severe, but in the case of 
sensitive persons cocaine can be used. 

Indications for the homoeopathic remedies useful in 
syphilitic affections: 

Arsenicum. — Inflammation and swelling of genitals; 
phagedenic and gangrenous chancres; copper- colored 
eruptions on genitals; burning pimples or pustular erup- 
tions on skin. 

Asafoetida. — Tertiary syphilis, especially after abuse of 
mercury; ulcers, particularly when affecting the bones, 



DIATHETIC DISEASES. 2S3 

discharging ichorous, fetid, thin pus; syphilitic caries 
and necrosis, with fetid and bloody suppuration: ulcers 
very st"sitive to touch: rs:re~e nocturnal pains. 

\ — Secondary syr :. 5 low-spirited; bones of 

5^_-. _:_:nful when lyinr in zztm: exostosis on head; 






A.r: :: sodii ^^ — S; ^^^i.is a::er azuse :f mer- 

c;:: :r ^htn, during st: -iir; :r .tr: ary stages :he 
bcnes ;: :iie nose are ize::ei ;r :J:e :hroat is ulcer- 
ated. 

Badiaga. — ^Syphilitic bubo, as hard as a stone, uneven, 
ragged at night violent lancinations as if with red hot 



£!i ~ T .-. r^i.^- -11 _i osis ! erysir-c-ir _ .i:r z s..mins; pamiu. eru-^- 

Bc juifolium. — ^Inve:tra:e cases 0: :er:: = ry 

syphilis. 

Calcarea fluar. — Chancres nari ml incnra'.ef. 

Calcarea sulpk. — In en:; :; c:n:r;l sn^rnra.in. 
Chronic suppurating s : : t 1 ^ - ' s . 

Car bo an. — ^Indurarei. ciit; - -:n lancinating or cut- 
ting pains; chancre n = s = l syrhilis 

Carbo veg, — Syrli: : : trs ~ :n lii^n :ri- : : :e- 
come irritable from :;; :a' ::-i::nrn: niir^n^ :: sires 
sharp, raggei nnierminei i ~:iir^e chin ache chen- 
sive; ulcer ranee' ene he he :: 'tre freely ~hen 



284 SKIN DISEASES. 

touched; vesicles or blisters on prepuce; burning of labia; 
burning eruptions on skin. 

Cinnaharis. — Swelling of penis; redness and swelling 
of prepuce, with painful itching; violent itching of 
corona glandis, with profuse secretion of pus; small 
shining red points on the glans; blenorrhoea of glans; 
sycotic excrescences; violent erections in the evening; 
small ulcer on roof of mouth, on the right side of tip 
of tongue, and on tip. 

Coral, rubr. — Chancre and gonorrhoea of glans. 

Corydalis. — Syphilitic nodes on skull; ulceration of 
fauces; profuse morbid secretion of mucus; tongue 
coated, with fetid breath. 

Ferriim phos. — Bubo with heat, throbbing or tender- 
ness. 

Hecla lava. — Destructive ulceration of the nasal bones. 

Hepar. — Mercurius-sj'philitic diseases of gums; pains 
in bones; chancres not painful, but disposed to bleed 
readily; margins of ulcers elevated and spongy looking, 
without granulations in their centre; buboes after mer- 
curial treatment; phimosis, with discharge of pus, accom- 
panied by throbbing; itching of penis, glans, and 
fraenum; ulcers like chancres on prepuce; humid sore- 
ness on genitals, scrotum, and folds between thigh and 
scrotum; humid, suppurating herpes praeputialis. 

Hydrastis. — Ozsena, with ulceration, bloody or mixed 
purulent discharge; mercurial salivation. 

Kali bichr. — Syphilitic affections of mouth and fauces; 
bone pains, with stitches as if from sharp needles; period- 
ical wandering pains all over the body; pustular syphilo- 
derma; indurated chancre. 

Kali hydroiodicum. — Secondary and tertiary syphilis; 
abuse of mercury. 

Kali mur. — Soft chancre, 3x tr. internally, and also 



DIATHETIC DISEASES. 285 

externally as a lotion; chronic stage of syphilis. In 
bubo for the soft swelling. 

Kali phos. — Phagedenic chancre and bubo. 

Kali sulph. — Syphilis, with yellow, slimy coating; 
tongue coated yellow; aggravation in the evening. 
Chronic syphilis. 

Lachesis. — Phagedejiic chancre; gangrene of glans and 
mons veneris; ulcers in throat and inflamed tonsils; 
caries of tibia; flat ulcers on lower extremities, with blue 
and purple areola. 

Lycopodiu7n. — Chancres with raised edges; indolent 
chancres, with thick, rounded, prominent margins, granu- 
lations flabby or absent; eruptions on glans; condy- 
lomata; syphilitic ulcers in mouth. 

Mercurius corros. — Excessive pain, swelling, and inflam- 
mation; regular indurated Hunterian chancre with lar- 
daceous bottom; swelling and redness of nose, ozaena; 
margins of soft chancre dark-red, painful, and easily 
bleeding; neighboring parts oedematous, hot, and painful; 
chancres on inner surface of prseputium or corona glandis; 
chancres with ichor adhering to the bottom of ulcer so 
firmly that it cannot be removed by washing; ulcers with 
thin pus, leaving stains upon the linen, as from melted 
tallow; phagedenic ulcers in mouth, gums, and throat, 
with fetid breath; tonsils swollen and covered wnth ulcers; 
bubo and swelling of glands generally. 

Mercur. iodat. rubr. — Hujiterian hard chancre; threat- 
ened gangrene of glans in paraphimosis; soreness of bones 
of face; sharp shooting stitches in the end of penis 
through the glans; old buboes, discharging for years. 

Mercur. vivus. — Red chancre on prepuce; spreading 
and deeply penetrating ulcer on glans and prepuce; pale- 
red vesicles, forming small ulcers after breaking, on 
glans and prepuce; painful bleeding chancres, with yel- 



286 SKIN DISEASES. 

lowish, fetid discharge; small chancres, with a cheesy 
bottom and inverted red edges; ulcers of glans and pre- 
puce, with cheesy, lardaceous bottom and hard edges. 

Mezereum. — Syphilitic periostitis; constant headache 
from tophi of skull; pains through whole body, with 
nightly pains in the bones, brought on by syphilis, 
mercury, or both combined; bones inflamed, swollen, 
especially shafts of cylindrical bones; fainting sort of 
vertigo; weary of life. 

Natrum mur. — Chronic syphilis, serous exudations, etc. 

Natrum sulph. — Condylomata of anus, syphilitic in 
origin, externally and internally. 

Nux vom. — Chancroid; shallow and fiat-bottomed ulcer- 
ation, showing a disposition to spread irregularly and 
indefinitely, exuding a thin, serous discharge. 

Nitric acid. — Phagede^iic chancres; ulcers in urethra, 
with purulent or bloody mucous discharge; ulcers bleed 
when touched, with exuberant, but pale and flabby 
granulations, irregular edges; moist condylomata, like 
cauliflower, or on thin pedicles; ulcers in vagina, looking 
as if covered with yellow pus, with burning pain or itch- 
ing; copper-colored spots on anus; syphilitic ulcers in 
mouth; syphilitic epilepsy and melancholia. 

Phosphoric acid. — Chancres with raised edges; chancres 
like an indolent ulcer, edges thick, rounded, and promi- 
nent; granulations pale and flabby, or absent; corroding, 
itching herpes praeputialis; blisters and condylomata on 
glans; sycotic excrescences, chronic, with heat, burning 
and soreness, when sitting or walking; figwarts, compli- 
cated with chancre; painless swelling of glans; interstitial 
ostitis of mercurio-syphilitic origin, with nocturnal pains, 
as if bones were scraped with a knife. 

Phytolacca. — Secondary syphilis; ulcers in throat and 
genitals; syphilitic rheumatism and syphilitic eruptions; 



\ 



DIATHETIC DISEASES. ' 287 

pains shift; joints swollen, red; periostitis; pains in 
middle of long bones, or attachment of muscles, worse at 
night, and in damp weather; glans inflamed, swollen; 
ulcers with appearance as if punched out, lardaceous 
bottom; weakness and prostration, but no paralytic symp- 
toms. 

Sepia. — hidolent chancre; burning itching, humid, or 
scurfy herpes praeputialis; chappy herpes, with a circular 
desquamation of skin; eruptions on glans and labia; itch- 
ing and dr}^ eruptions on genitals; chancres on glans and 
prepuce. 

Silicea. — Chancres with raised edges; inflamed, painful, 
irritable chancres, with discolored, thin, and bloody dis- 
charge, granulations indistinct or absent; painful erup- 
tions on mons veneris; itching, moist or dry eruptions of 
red pimples or spots on genitals; chronic syphilis with 
suppurations or indurations; ulcerated cutaneous affec- 
tions where mercury has been given to excess, nodes in 
tertiary syphilis; caries and necrosis with discharge of 
offensive pus. 

Staphisagria. — Soft, humid excrescences on and behind 
corona glandis; dry, pediculated fig- warts; excrescences 
and nodosities of gums; female sexual organs painfully 
sensitive, especially when sitting; mercurialism. 

Stillingia. — Secondary syphilis ; extreme torture from 
bone-pains; nodes on head and legs. 

Sulphur. — Inflammation and swelling of sexual organs, 
with deep rhagades; burning and redness of prepuce; 
deep suppurating ulcer on glans and prepuce, with puffed 
edges; phimosis, with discharge of fetid pus; glandular 
swellings, indurated or suppurating. 

Thuja. — Chancres, with pain as from a splinter stick- 
ing; sycotic moist excrescences on prepuce and glans; 
moist mucous tubercles; itching ulcers with unclean 
bottoms, or whitish chancres with hard edges. 



288 SKIN DISEASES. 

Condylomata, Sycosis, Fig- warts. 

These excrescences are a morbid growth of the skin and 
mucous membrane, or, better defined, of the subcutaneous 
and submucous cellular tissue. They are of different ex- 
ternal appearance, according to their coating. When 
they are covered by the epidermis they appear dry, hard, 
horny, like common warts; when covered with thin 
epithelium, or when they are entirely bare and excoriated, 
they appear soft, moist and secrete more or less of a 
slimy, acrid, badly-smelling fluid. These latter are the 
geyiuine syphilitic condylomata or tubercula mucosa. 

Their forms are likewise various; some are flat, upon a 
broad basis; others are conical, growing on a pedicle; others 
appear like a cock's comb. The flat fig- warts are chiefl}'' 
found around the anus, between the glutens muscles; on 
the perineum, scrotum, external skin of the penis, glans 
penis, and on the external surface of the labia in women; 
whilst the conical and pediculated are usually found in the 
entrance of the vagina, on the clitoris and even far back 
in the vagina, and on the neck of the womb; in males on 
the interior surface of the prepuce; also between the 
nates. They sometimes grow so luxuriantly that the 
whole vagina and interior surface of the prepuce is 
covered by them. A third kind is quite small, in the 
shape of pin-heads, which are generally found around the 
corona in men, and on the interior surfaces of the labia in 
women. In secondary syphilis they appear also in other 
localities, especially on the tongue, corners of the mouth, 
chin, face, forehead, eyelids, iris, scalp, meatus auditorius, 
axillae, nipples, and between the toes. Soon after the 
outbreak of this pest in the middle ages we read of condy- 
lomatous excrescences in the face, which were of a finger's 



CONDYLOMATA. 289 

length, and which caused, for their bearers, more ridicule 
than compassion. 

Treatment. — Keep the parts clean and dry. If the 
excrescences are troublesome, excise them with the knife 
and afterwards appl}^ a mercuric bichloride lotion, strength 
one to two grains to the ounce of water. The principal 
internal remedy is Thuja. 

Therapeutic Hints. — For the mucous tubercles the 
main remedies are: Cinnba., AHtr. ac, Thuja. 

Fig-warts, when complicated with gonorrhoea^ require 
Thuja, Cinnba., Nitr. ac, Sulph., Lycopodium. 

When complicated with chancre, Cinnab., Nitr. ac.^ 
Phos. ac, Staph., Thuja. 

When jlat, Magnes , Nitr. ac. 

When exuberant, like cauliflower or mulberries, Thuja, 
Staph. 

When fan-shaped, Cinnab. 

When growing on pedicles, Lycopod. , Nitr. ac. 

When conical, Merc, solub. 

When dry, Thuja, Staph., Merc, solub., Nitr. ac, 
Lycopod: 

When moist, S2ipp2irating , Nitr. ac, Thuja, Sulph., 
huphras^ 

When soft, spongy, Sulphur. 

When intolerably bunmig and itclmig, Sabina. 

Cinnabar. — Fan-shaped fig- warts accompanied by tetter. 
In scrofulous infants and children. 

Euphrasia. — Fig-warts at the anus. 

Mercur. cor. — Dry fig- warts, or else fig- warts accom- 
panied by acrid discharges. Soft, flat condylomata. 

Mercurius nit. — Filiform fig- warts. 

Mercurius prcBcip. ruber. — Fissured condylomata. 

Mercur. sol. — Conical fig-warts; small, itching pimples 
which ulcerate and become incrusted; mild types. 



290 SKIN DISEASES. 

Nitr. ac. — Pediculated and pen-shaped, moist condy- 
lomata; fig- warts on the glans. 

Sabina. — Condylomata attended with itching and burn- 
ing. 

Sarsaparilla. — Flat fig -warts. 

Staphisagria. — Cock' s-comb-shaped fig-warts. 

Sulphur. — Soft, spongy fig- warts. 

Thuja. — Cauliflower excrescences. Condylomata on 
the penis, vulva and about the anus; broad, flat condy- 
lomata; after iritis, tubercles or warty excrescences on 
the iris. 

Leprosy. 

lyCprosy is a disease that has been known from the 
earliest ages, and has prevailed among all races and in 
all climes. 

At present it is most wide-spread in countries lying 
both to the north and to the south of the temperate zone 
and among the less enlightened people of the earth. 
To a limited extent, however, it is met with in Europe 
and the United States. 

The disease manifests itself in three chief forms or 
phases of development, known as the macular, tuber- 
cular, anaesthetic. The first is characterized by the de- 
velopment of brownish discolorations of varying size and 
number. These, after an existence of months or years, 
may lose their heightened color and become pigmentless, 
and the cutaneous nerves in the affected parts lose their 
sensibility. 

The tubercular form is characterized by the develop- 
ment of tubercles upon various parts of the body. 
These exhibit a slightly heightened color, becoming 
later somewhat copper-colored, and affect a preference for 
the face, especially just above the eyebrows and upon 



LEPROSY. 291 

the nose and ears, but may, and usually do, appear upon 
the extremities. 

In the anaesthetic form, bullae, usually solitary, de- 
velop upon various parts of the integument. They per- 
sist for a short time only and leave behind them discolora- 
tions, which in time may become whitened and 
anaesthetic. In this form of the disease there is grave 
implication of the principal nerve-trunks of the ex- 
tremities. This is notably the case with the ulnar nerve, 
which in cases moderately advanced may be readily per- 
ceived as a thickened cord just above the head of the bone 
whose name it bears. In this form, especially, pain in 
the extremities is a more or less prominent feature. 
Connected with the development of the disease, anaes- 
thesia of the integument, chiefly of the extremities, be- 
comes a prominent feature. The gradual destruction of 
the ulnar nerve leads to impairment of its functions and 
atrophy of the more distant parts to which it is distributed. 
This atrophic action is most distinctly manifested in the 
fingers and toes. Fissures occur in the integument, and 
absorption of the phalanges takes place and leads to loss 
of these parts. The separation usually occurs at some 
point between the joints rather than at the joints them- 
selves. A continuance of the morbid action may result 
in loss of all the phalanges, and even of some of the 
metacarpal and metatarsal bones. 

Leprosy is essentially a chronic disease. Before the 
appearance of cutaneous or nervous lesions there usually 
exists a prodromal period of several years' duration, with- 
out definite symptoms other than impairment of the gen- 
eral vigor. During this period it is hardly possible to 
make a diagnosis of the impending trouble. After the 
disease, however, is fully developed, ten, fifteen, or 
twenty years may pass before the fatal termination. 



292 SKIN DISEASES. 

After careful investigation Drs. Fox and Graham arrive 
at the following conclusions concerning leprosy: 

1. Leprosy is a constitutional disease, and, in certain 
cases, appears to be hereditary. 

2. It is undoubtedly contagious by inoculation. 

3. There is no reason for believing that it is transmitted 
in any other way. 

4. Under certain conditions a person may have leprosy 
and run no risk of transmitting the disease. 

5. It is not so liable to be transmitted to others as is 
syphilis in its early stages. There is no relation between 
the two diseases. 

6. Leprosy is usually a fatal disease — its average dura- 
tion being from ten to fifteen years. 

7. In rare instances there is a tendency to recover after 
the disease has existed many years. 

8. There is no valid reason for pronouncing the disease 
incurable. 

9. Judicious treatment improves the condition of the 
patient and often causes a temporary disappearance of the 
symptoms. 

10. There is a ground for the hope that an improved 
method of treatment will in time effect the cure of leprosy, 
or at least that it will arrest and control the disease. 

Dr. Perry has arrived at the following conclusions, 
after years of study and residence in India: 

1. Leprosy is an endemic disease, malignant, constitu- 
tional, progressive; evidenced by tubercular degeneration 
of the tissues, and accompanied by anaesthesia, ulcera- 
tion, and gangrene; terminates in death from exhaustion, 
pyaemia, or rupture of the arteries. 

2. That it is due to a specific bacillus he considers an 
unsettled point. 

3. That leprosy is contagious only by inoculation, the 



LEPROSY. 293 

direct transmission of the virus into the blood of healthy 
persons. This assertion does not exclude the transmis- 
sion of the disease by clothing, tools, etc., which have 
been used by lepers. 

4. The disease is practically limited to people living 
upon a fish diet along the sea coast. 

5. It is incurable. The best treatment is only pallia- 
tive. His experience with iodide of potash, iodoform, 
mercury, and other so-called antisyphilitics having been 
as satisfactory as with chaulmoogra oil and other 
rarer and costlier drugs. 

6. The average life of the leper, after the full develop- 
ment of the disease, is from ten to fifteen years. This 
does not include the prodromal stage. Some cases die 
sooner, and some live much longer. 

7. The period of incubation is less than one year; the 
prodromal stage may last for five or more years. Leon- 
tiasis may develop in twelve months, and may be the 
only hint of the latent disease for years, until some 
exciting cause brings it out. 

8. Hereditary leprosy does not usually develop until 
the age of puberty, unless there be some exciting cause. 
This exciting cause may be inflammatory skin disease, 
suppurating wound, or prolonged illness. 

Etiology. — If we may judge from Holy Writ, the an- 
cient Jewish lawgivers regarded the disease as contagious. 
Modern science declares that it is not. The discovery 
in recent times of a peculiar bacillus by Hansen gives a 
clue to the medium of contagion, and corroborates the 
results of careful clinical observation. While we cannot 
doubt the possibility of contagion, we must admit that 
within the temperate zones the direct transfer of the 
disease from one person to another has been very rarely 
observed. It is by no means unusual for a Caucasian to 



294 SKIN DISEASES. 

contract the disease when dwelling among the natives 
where it is endemic; but it is extremely rare for him, 
on returning to his native country, to convey the malady 
to those with whom he associates. During the past 
several years there have been a large number of lepers 
who have passed months and sometimes years in the hos- 
pitals of New York, and yet not a single case of leprosy 
has developed in this city. 

Fox says: "The causes of propagation are mainly 
these: 

1. Intermarriage of the leprous or with the leprous. 

2. Hereditary transmission, 

3. Inoculation and cohabitation. 

4. Vaccination (?). 

As to intermarriage, little need be said. It sufficiently 
accounts for the occurrence of a large number of cases of 
leprosy in the offspring of lepers, and the continuous 
intermarriage of people of the same caste in India, en- 
forced rigidly by custom and superstition, tends greatly 
to the spread of leprosy hereditarily. 

Secondly. — As regards hereditary influence, this is 
most marked in children who are begotten by lepers far 
advanced in the disease. 

Thirdly. — As to cohabitation and inoculation. Of 
course, these are not such potent causes as intermarriage 
and hereditary tendency in spreading leprosy, but still it 
is probable that they may account for a certain number of 
cases. 

It has been said that leprosy may be communicated by 
vaccination, but if so it must be infinitely rare and 
scarcely worthy of being taken into account. 

Prognosis. — The prognosis is uniformly unfavorable — 
that is, when the disease is left to its natural course. 
Spontaneous recovery, if it ever occurs, is extremely 



LEPROSY. 295 

rare. A few cases of cure have been reported, but a 
shade of doubt hangs over them. Mitigation of the 
affection, and even abeyance of the symptoms for a time, 
are by no means uncommon. 

Treatment. — Good food and good hygienic surround- 
ings are of the first importance in the treatment of 
leprosy. Strychnine and chaulmoogra-oil are highly 
recommended by the old school. They claim that with 
these four means at command the majority of cases of 
leprosy can be greatly benefited. They give the drugs 
in full doses, the oil being applied externally as well as 
internally. 

Surgeon-major Peters gives as the result of two years* 
experience at a leper asylum in India, with twenty-nine 
cases, improvement in all the cases by the following plan: 
The patients had to rub the body for two hours early in 
the morning with Carbolic oil, i to 40; then bathe in 
warm soap and water. Afterwards an emulsion composed 
of Gurgium oil and lime water was rubbed into the 
affected parts only, any ulcerations being filled with 
cotton smeared with the same. Under this treatment the 
ulcers healed rapidly, while the anaesthetic parts and 
nodules remained unimproved They, however, were 
benefited by Cashew-nut oil rubbed on to blistering. 
Internally, the remedy administered was as follows: 

^. Chaulmoogra Oil, m. v. 

Sodas Bicarb., gr. v. 

Aquae Menthae Pip. , ^ j . 
M. Size of dose not stated. 

Locally, warm baths with Gurgium oil are highly 
recommended. 

The principal homoeopathic internal remedies are 
Hydrocotyle^ Hoang nan and Piper methysHcum. 

Others may be indicated as follows: 



296 SKIN DISEASES. 

Anacardium. — Numbness and feeling of pins and 
needles in affected parts, which are cold; patches of 
raised and hardened skin on face and arms; perfect 
anaesthesia of affected parts; weakness and prostration. 

Alumina. — Copper-colored tubercles in face; leprous 
spots on legs; lips swollen; nose heavy; husky voice; 
hypersesthesia; ulcers on planta pedis. 

Arsenicum. — Yellow or white spots; tubercular swell- 
ing in nose; burning ulcers at the ends of the fingers, at 
the toes, soles of feet, navel, cheek; raised up tubercles; 
loss of hair and eyebrows; livid tubercles on any part of 
the body; hyperaesthesia and anaesthesia alternating; 
general prostration. 

Arsen. iod. — Pricking sensation in the skin; loss of 
the voice; enlargement of the glands; hoarse cough; fall- 
ing off of the fingers and toes; ozaena; tubercles dirty 
looking. 

Aurum. — Melancholy disposition; discharge from the 
nares very offensive; absorption of the bones of the nose; 
has no desire to talk about sickness. 

Calotropis gig. — Tubercular leprosy; lassitude, indis- 
position to move; loss of energy; apathy and obstruction 
of the capillaries; intolerable itching over the whole 
body. 

Carica papaya. — Tubercular leprosy. 

Colocynth. — Desquamation of the whole epidermis; ab- 
scess of axilla. 

Crotalus. — Swelling of the limbs or body ; spots 
appearing like gangrene. 

Cupmm. — Leprous eruptions ; cramps ; suffocating 
spells. 

Graphites. — Leprous spots, coppery, annular, raised on 
the face, ears, buttocks, legs, and feet ; ulcers on toes. 



LEPROSY. 297 

crusts in nostrils ; skin cracks and discharges a sticky 
fluid. 

Hydrocotyle, — Well-marked cases of tubercular leprosy; 
leonine face ; nose flattened and swollen ; lobes of the 
ears pendulous and swollen ; ulcers in the alse nasi and 
corners of the mouth ; ears discharge ; hands and feet 
swollen so that fingers and toes spread apart ; itching of 
any part of body ; feeling of lassitude ; yellowish or 
reddish spots on the trunk and extremeties. 

lodujn. — Emaciation marked ; swelling of the glands ; 
when mercury has been taken in large quantities ; loss of 
voice and hoarseness ; voracious appetite. 

Kali bichrom. — Brownish colored spots ; ulcers with an 
unhealthy look ; blisters on the extremities ; little boil or 
pustules on any part of body ; thick, tough discharge 
from nose ; hard plugs in nose ; thick, ^^ellow, putrid 
discharge from the ears ; ulcers on tongue and on 
cornea. 

Kreosote. — Soreness on the nose ; swollen gums ; 
painful ulcers ; wheals like urticaria ; numbness in 
different parts of the body. 

Lachesis. — Spots yellow, red, green, lead and copper 
colored, pale livid ; hard and pale swelling ; large boils ; 
ulcers surrounded by nodes and vesicles ; the muscles 
fall off in shreds from the bones ; bloody serum discharge 
from the nose, ears and mouth ; obstinate ulcers wdth 
black spots in the granulations. 

Madaru albuin. — The whole surface of the skin 
becomes leprous ; livid and gangrenous tubercles ; 
thickening of the whole skin. 

Mercurius. — Falling out of the teeth ; absorption of the 
small bones ; swollen gums ; sore tongue ; flat indolent 
ulcers. 

Natrum carb. — Spots and tubercles all over the face, 
20 



298 SKIN DISEASES. 

arms, thighs, legs, which ulcerate ; ulcers in the nostrils 
and on the heels. 

Petroleum. — Tubercles on the face; herpetic and tuber- 
culous spots on the body; ulcers of fingers, tibia; 
unhealthy skin with brown spots; skin dries and forms 
deep cracks; falling out of hair; hypersesthesia of scalp 
and ears followed b}^ anaesthesia; hoarseness, suffocating 
cough, numbness of extremities. 

Phosphorus. — Later stages of the disease; brown spots 
on an even base; boils; spots like blood blisters on the 
body; tubercles on the trunk, buttocks; thick patches on 
face and arms; discolored borders around the white 
spots; hair falls out; tension in the fingers, and dullness 
towards the end; great debility with increa.se of sexual 
desire. 

Rhus tox. — Scalp sensitive, cannot bear to have the 
hair touched; pulsation in the ears; loss of smell; 
swollen face so that patient is not recognized; 
tubercles with sharply defined margins; bright red skin, 
violent itching; hardness and thickening of skin on any 
part of body. 

Secale. — Can hardly talk, the tongue will not respond 
to the will; fingers and toes drop off; falling out of the 
hair; eyes look sunken; cold, dried-up-looking skin. 

Sepia. — Swelling of forehead, around temples; face 
thick, covered with tubercles; leonine face, pendant ears; 
eyes red, dull, weeping; purulent discharge from nose; 
tubercles and spots all over the body; gnawing ulcers on 
fingers and toes; excoriation at the tip of tongue; 
discharge from the swollen ears; nose and lower lip 
swollen; red herpetic spots at the elbow and hip; herpetic 
sores; white spots and ulcers on the articulations of the 
fingers; coppery tubercular spots all over the body, 
especially on the buttocks, arm-pits; tubercles on the 
face, trunk, buttocks, prepuce; brownish spots on face; 



morvan's disease. 299 

skin peels off from hands and feet; nails look dried up 
and deformed; falling out of the hair and eyebrows; loss 
of smell; breath offensive. 

Silicea. — Induration of nose, with ulceration and 
discharge; palsied hands; white spots on cheeks; coppery 
spots and hard tubercles on testicles and buttocks; ulcers 
at tips of fingers; shortening of the hamstrings. 

Sulphur. — The usual antipsoric indications. 

Woorali — Obstinate boils^ that will not heal; slowly 
forming and suppurating pimples; dirty looking skin; 
blood oozes through the skin; tubercles on nose; stoppage 
of nose, with swelling of parts; falling of the hair; 
swelling of the lobes of ears; falling out of the teeth; 
discharge of matter from the ears; tonsils inflame and 
suppurate. 

Hura Bras.y Guano, Helleboi^ous foetidus and Veronica 
may be compared. 

Morvan's Disease. 

Morvan's disease must be differentiated from Sclero- 
dactily, from Lepramutilans, and from symmetric gan- 
grene of the extremities. 

The analgesic paresis with panaris of the superior ex- 
tremities was first described by Morvan. The patient 
complains at first of neuralgiform pains in the fingers, 
which are soon followed by a paretic state with muscular 
atrophy, more or less pronounced, in the hands and 
forearms, sometimes spreading through the whole arm 
and other parts of the body. There is at the same time 
analgesia and anaesthesia, especially for the touch, for 
pain and temperature (here it is necessary not to mistake 
it for syringomyelia, where there is no anaesthesia, but 
only a relative analgesia and especially thermo-anaes- 
thesia). This state is followed by panaritiae, which start. 



300 SKIN DISEASES. 

like any other plain panaritium, with redness, heat and 
swelling, but it soon shows its malignant character, as 
necrosis of the bone follows, destroying not only the 
upper phalanx, but sometimes also the others, resulting 
in mutilations. We meet here also multiple panaritiae, 
attacking nearly all the fingers, which may follow one 
another at shorter or longer intervals, so that years may 
intervene between them. Though the first panaritium 
may be painful, the subsequent ones are usually painless. 
Trophic troubles are more or less observed, as more or 
less deep rhagades, ulcerations in the folds of the skin, 
extending to the tendinous sheaths, which are bathed in 
suppuration, but all is of an indolent character. The 
nails fall off or become deformed as in no other affection. 
Finally the whole hand becomes livid and its temperature 
below the normal. 

Prognosis in relation to the use of the upper extremi- 
ties is bad, as the disease leads to incurable deformities 
and mutilations. It attacks more often males than 
females, of all ages, and whether traumatism is to blame 
for it remains more than doubtful. 

It is easy to differentiate it from Ball's sclerodermitis, 
for here one never meets necrosis of the bone, nor are 
bone pieces discharged; the mutilations take place grad- 
ually by a kind of absorption of the tissues of the fingers; 
nor is there any paresis or anaesthesia. Finally the 
sclerodermic mark is specific, and can never be mistaken 
for anything else. 

In relation to anaesthesia with its atrophy the patient's 
hands become very similar to those of the monkey, and 
the lesions are mostly symmetric. The same trophic 
troubles may be found anywhere on the body and ulcera- 
tions are frequent, and the leprous spots on the skin of 
such patients are characteristic and known as morphea 



301 

alba or rubra. Lepra is an exotic plant and so far con- 
fined to few countries. 

Nor can Morvan's disease be mistaken for syringo- 
myelia, characterized, as it is, by more extensive mus- 
cular atrophy, and though the sensation of contact is pre- 
served, the sensibility to heat and cold is abolished over 
large surfaces of the body, a characteristic which is only 
partially met with in hysteria. The rhagades, the 
arthropachies and the scoliosis belong to both, but a 
panaris is an exception, while in Morvan's disease it re- 
mains the predominant phenomenon. 

Abnormal sensitiveness of the fingers, painful at first, 
with redness and swelling, then bullae which break and 
dry up, followed by atrophy of the upper phalanx, which 
becomes deformed and absorbed. 

Nobody as yet has discovered the origin of the malady, 
and none has yet given a treatment for it. We may 
claim that constitutional treatment may eradicate the 
poison and Homoeopathy is rich in resources. 

Thuja, Fluoric acid, Silicea, Sulphur and others are of 
great assistance. 

Thuja. — Erysipelatous swelling of the tips of the 
fingers and of the fingers; nails are crippled, discolored, 
crumbling off; twitchings of the muscles of the arms; 
coldness and sensation of deadness of the fingers and tips 
of the fingers; stinging pains in the arms and in the 
joints; emaciation and deadness of the affected parts 
dirty and brownish color of the skin. 

Silicea and scoliosis go hand in hand, and according to 
some authors it is found in nearly half the cases of 
Morvan's Disease. It is also complementary to Thuja, 
and in most cases where Silicea suits there is a tendency 
^to chronicity of the disease; emaciation and atrophy of 
affected parts; paretic states; nails rough and yellow; 



302 SKIN DISEASES. 

pain as if panaritium would form on left index; dryness 
of tips of fingers; ulcers about nails; felons with violent 
shooting pains deep in the fingers, with great restlessness 
and irritability. 

Sodium sulphate is also correlated to Thuja. Perhaps 
it may come in at a later stage when the paronychia sets 
in painless or with hardly any pain. Among its symp- 
toms we read twitchings of the hands, trembling of the 
hands on waking, and also when writing; loss of strength 
of the hand, is unable to hold anything heavy; tingling, 
ulcerative ])ain under the nail; internal coldness; with 
yawning and stretching. 

Graphites has emaciation of the hands, distortion of 
the fingers, gouty nodosities on the finger-joints; thick 
and crippled nails; soreness between the fingers; sensa- 
tion of debility without pain and liability to take cold. 
Cracks and fissures anywhere are often the key-note to 
the use of this drug, and as it has a long action, it ought 
certainly be of benefit in such a chronic affection as 
Morvan's Disease. 

Sepia also has diseased and crippled nails with painless 
ulcers on the joints and tips of the fingers and paralytic 
drawing and tearing in arms and fingers. Venosity and 
stagnation is the red thread which goes all through the 
pathogenesis of the drug; it is also a long lasting remedy, 
hence the neuraesthenia and the paretic condition, and 
the more we consider all these diseases, except lepra, of 
constitutional origin, the more will we be able to prevent 
the deformities which, when once present, are out of the 
pale of therapeutic measures. 



CHAPTER XIII. 

HYPERTROPHIC AND ATROPHIC AFFEC- 
TIONS. 

Under the terms h^^pertrophy and atrophy ma}' be in- 
cluded all cases of development in excess of the normal 
tissues of the skin on the one hand and wasting on the 
other; the atrophy and hypertrophy being in each case 
primary conditions. 

The maladies ranking under these two classes may be 
arranged as follows: 

A. Hypertrophic diseases, com^rismg: — i. Diseases of 
the epithelial layer of the skin, including callosities, 
corns, and horns, in which the epithelial tissue is specially 
affected. 2. Diseases involving the dermic portion, in 
which the true skin is affected with or without the 
epithelium. In some cases the papillary layer is chiefl}^ 
affected, but in connection with augmented production of 
the epithelium also, as in ichthyosis and xeroderma. In 
other cases the fibro-cellular tissue of the corium proper 
is the special seat of change, as in the diseases termed 
scleroderma, keloid, fibroma, Elephantiasis iVrabum, and 
derma tolysis. 3. Diseases seated in the vascular 
structures, including such growths as vascular naevi. 

B. Atrophic diseases, including general wasting and 
senile atrophy, and local or linear atrophy, which will be 
incidentally noticed together with morphoea. 



304 SKIN DISEASES. 

Hypertrophic Affections. 

We will first deal in detail with hypertrophic affec- 
tions. It will be understood that no reference is made 
in this chapter to secondary or accidental hypertrophy — 
the consequence of congestion or inflammatory conditions, 
but to those diseases in which hypertrophy is the promi- 
nent or only condition. 

Corns. 

These are composed of an accumulation of the cells of 
the horny layer, which, generally, are pressed together 
into a conical mass that dips deeply downwards. The 
papillae beneath may be enlarged, but are usually 
atrophied. The corn mass presses even upon the rete 
cells, and it also obliterates more or less the sweat glands. 
Corns are caused by pressure and friction; they are of two 
kinds — the hard ordinary corns, and soft corns. The 
soft corns occur between the toes, and being saturated 
with the secretion of the part, are moist and soft; gen- 
erally there is some serosity effused under the upper 
layers or the bursse normally found at the parts over the 
joints of the toes where the corns form, enlarge and pour 
out fluid, which is discharged from a little central 
aperture. 

Treatment. — The shoes or boots worn must fit the 
foot — neither too small nor too large. The corn may be 
gotten rid of by soaking it in warm water, after which 
the outer layers may be removed by a sharp knife, and a 
slice of lemon bound upon it, and worn during the night. 
This treatment continued for three or four nights, the 
corn can be removed with but little pain. 

Flexible or arnicated colloid may be used as a dressing 
for painful soft corns. 



HYPERTROPHY OF THE PAPILL.E:. 305 

Ringed corn plasters will protect the corns from press- 
ure. 

If the corns are inflamed and painful, a veratrum 
viride or arnica lotion, one part to two, may be used. 

A lotion, composed as follows, applied once or twice a 
day with a camel's hair brush, has been used with great 
success in removing corns: 

9^. Salicylic acid, drachm j. 
Ext. Cannabis Ind., grs. x. 
Collodion, ^j. 
M. S. Apply as directed above. 

Another excellent application is as follows: 
9. Acid Salicylic, drachm j, 

Emplast. Saponat, Jjjj. 
M. f, empl. Sig. : Apply on lint. 

Antimon. crud. is the principal internal remed}^ for 
hard corns, and Sulphur for the soft variety. 

Dr. Berridge reports a case of soft corn between fourth 
and fifth toes of right foot; the corn shoots and burns; 
also, dull aching in outer side of right ankle extend- 
ing up to hip, as cured by the internal use of Wiesbaden 
200, a dose every other day for fourteen days. 

Callosities are merely hardened conditions of the skin 
produced by pressure, differing from corns rather in the 
fact that they are on a larger scale than by any other 
feature. 

Hypertrophy of the Papillae and Epithelium 
Conjoined. 

Horns. — These may be sebaceous in origin; usually, 
however, they are made up of hypertrophied papillae, 
each containing one or more vessels and being covered by 
epidermis; on section they have a granular texture 
pierced with small orifices, and when dry, numerous con- 



306 SKIN DISEASES. 

centric cracks. These orifices are the sections of little 
blood-vessels; a clear amber-colored circular area sur- 
rounding each of the vessels, which are separated by the 
general granular structure of the mass, incapable in the 
compact part of the horn of being reduced to its ultimate 
original elements. The central parts of the horn are 
more compact and less vascular than the outside. 

Verrucae, or Warts. 

These are little raised tumors, sessile or pedunculated, 
hard, generally round, rugose, and mammillated. They 
are made up of coherent and enlarged papillae, each con- 
taining a loop of blood vessels, and more or less nerve- 
tissue, especially at their base. The sessile warts, or the 
true hypertrophous papillae, are seen mostly on the hands 
in children; they may be multiple, solitary, or aggre- 
gated in clusters. They may form a fiat mass or present 
a digitate appearance. Warts are often the result of 
syphilis about the anus, vulva, penis, but they may also 
arise from simple irritation. 

Venereal warts are pinkish or reddish vascular vegeta- 
tions, and occur for the most part on the genitals, pref- 
erably on the penis and labia. They may also form 
about the mouth and anus, in the axilla and between the 
toes. They are apt to grow very rapidly, and may attain 
considerable size. They are caused by the contact of 
irritating fluids, and may be either dry or moist, accord- 
ing to their location. They may occur in connection with 
gonorrhoea, but are never like the condylomata, a sign of 
constitutional syphilis. 

The causes of warts are unknown; they appear some- 
times to be contagious. The local treatment consists in 
destroying the abnormal growth by caustics — the acid 



VERRUCA, OR WARTS. 307 

nitrate of mercury, caustic potash, arsenical paste, 
perchloride of iron, or chromic acid. The smaller warts 
may be removed by the curved scissors, and the larger 
and more vascular ones by the curette, ligature or gal- 
vano-caustic wire. 

Venereal warts need the strictest cleanliness. The dry 
ones may be treated locally by thuja or mercuric bichlor- 
ide lotion. The moist ones respond best to dusting 
with the mercuric chloride. 

Thuja externally and internally has great reputation 
in removing all kinds of warts. 

Moles may be removed by the topical use of the acid 
nitrate of mercury. 

The following repertory of warts and condylomata, 
prepared by Dr. Olin M. Drake, is so complete and ex- 
cellent, that I transcribe it here: 
Warts, confinement, following, small: Calc. c. 

girls, upon young: Sep., Sulph., Thuja. 

horses, upon: Lach., Thuja. 

upon, about the head and ears; bell-shaped, small 
at the attachment and one to one-and-a-half 
inches long: Thuja. 

imagines w. upon the body: Mez. 

internal: Caust. 

isolated: Calc. c, Caust., Lyco., Natr. c. 

onanists, upon: Nitr. ac, Sep., Sulph., Thuja. 

salt, from abuse of: Natr. mur.. Nit. d. s. 

Locality. 

Anus, about: Aur., Thuja. 

Arms, upon: Ant. cr., Ars., Calc. c, Caust., Dulc, 

Ferr. ma.. Lye, Natr. c, Nat. sulph., Nitr. ac, 

Rhus tox., Sep., Sil., Sulph., Thuja, 
left forearm: Sulph. 



308 SKIN DISEASES. 

bend of elbow: Calc. c. 
wrist (left) : Ferr. ma. 
Back: Nat. c. 

Body: Caust., Medor., Thuja. 

Buttocks, small, scattered, flat, grayish-brown: Con. 
Cheek (left): Calc. c, Sep., Thuja. 
Chest: Aur., Calc. c, Nit. ac. 
Conjunctiva: Thuja. 
Cornea, warty in appearance: Sil. 
Ears, behind: Calc. c, Thuja. | 

wart-like growths: Calc. c. j 

Eyeballs, sensation as though was studded with: 

Euphr. 
Eyebrows, upon: Anac, Caust., Thuja. 
Eyelids: Calc. c, Caust., Mag. s., Nit. ac, Sulph., 

Thuja. 

upper: Calc. c. , Mag. s. , Nitr. ac. 
Eyes, under: Sulph. 
Face, upon: Alco., Am. m., Calc. c, Caust., Dulc, 

Ka. bi., Ka. c, Mag. s., Natr. m., Nitr. ac, Sep., 

Thuja. 
Feet: Calc. c, Sulph. 

soles: Sep. 
Fingers: Ambra, Ars., Bar. c, Berb., Calc. c, Carb. 

an., Caust., Dulc, Ferr., Lac c, Lach., Lyco,, 

Nat. m., Nat. sulph., Nit. ac, Ox. ac, Pal., Petrol., 

Psor., Ran. b., Rhus t., Sars., Sel., Sep., Sulph., 

Thuja, Verrucinum. 

index finger: Caust. (right), Lyco. (left), Thuja. 

little finger: Caust., Lace 

middle finger: Berb., Lach. 
finger, back of: Lach. 

ring finger: Nat. sulph. 

back of: Dulc, Lach. 



YERRUC^, OR WARTS. 309 

side of: Calc. c, Sep., Thuja. 

tips of : Caust., Thuja. 

joints, around: Sars. 

knuckles, on: Ox. ac, Pal., Sal. 

close to the nails: Caust. 

rudimentary: Berb. 

thumb: Lach., Ran. b., Thuja. 

left hand: Psor. 
Forehead, upon: Nitr. ac. 
Genitals, upon: Calc. c, Cinnab., Eucalyp., Nit. 

ac, Pho. ac. Sec c. Thuja. 

upon glans penis: Nit. ac. , Pho. ac, Thuja. 
OS uteri: Calc. c, Nit. ac. Sec. c, Thuja, 
stinging and burning, when urinating: Thuja. 

papilloma urethrae: Eucalyp., Thuja. 

prepuce, frsenum and inner surface, bleeding when 
touched: Cinnab., Eucalyp. 
Hands, upon back of: Ars., Dulc, Ferr., Nat. c, 

Nit. ac, Thuja. 

left: Ferr. ma. 

right: Ars. 

ball of the: Berb. 

inside of: Ruta. 

knuckles: Ox. ac, Pal., Sel. 

left: Ferr. ma., Psor., Thuja. 

onanists of: Nitr. ac, Sep., Sulph., Thuja. 

palm of: Anac, Nat. m., Ruta. 

wart-like induration in the palm, after a long con- 
tinued pressure on the part: Borax. 

right: Ars., Caust., Nat. sulph.. Thuja. 
Head, upon: Caust., Sep. 

Iris: Thuja. 

lyips: Caust., Con., Nat. m.. Nit. ac, Thuja. 

upper, smart and bleed on washing: Nit. ac 



310 SKIN DISEASES. 

drawing pain in an old w.: Con. 
Mouth and chin, about the: Calc. c, Calc. ph., Cun., 

Ka. ca.. Ivy CO., Medor., Psor. , Sep., Thuja. 

thickly studding the mouths of sheep: Calc. c. 
Neck, upon: Ant. cr., Calc. c, Lyco., Nit. ac, Sep., 

Syph., Thuja. 

right side, filled with blood: Thuja. 
Nose: Alco., Caust., Laur., Nit. ac, Thuja. 
Sternum: Nit. ac. 
Thighs, upon: Medor. 
Thumb, upon: lyach., Ran. b. , Thuja. 
Toes, upon: Spig. 
Tongue, upon: Aur. m., Aur. m. n., Mang., Thuja. 

Objectively considered. 

Bleeding: Calc. c, Caust., Cinnab., Ferr. ma., Lyco., 
Natr. c, Nitr. ac, Pho. ac, Rhus t., Staph., Thuja. 
Breaking open: Calc. c 
Brittle: Ant. cr. 
Cauliflower, like: Nitr. ac. Ran. b., Thuja. 

on outer side of terminal phalanx of right thumb: 
Ran. b. 
Cleft. See jagged. 

Color, almost the color of the skin: Calc. c 
dark: Sep., Thuja, 
red: Ars., Bell , Calc c, Caust. 
size of a bean: Calc c 
and angry looking: Ars. 
circles around with: Caust. 
streaks with: Bell. 
Flat: Ant. cr., Berb., Dulc, I^ach., Ruta, Sep., Verru- 

cinum. 
Groups or crops, in: Dulc, I^ach., Nat. m., Psor., 
Sep., Thuja. 



VERRUCA, OR WARTS. 311 

Hollow, become: Calc. c. 

Horny or hard: Ant. cr., Borax, Calc. c, Caust., 

Dulc, Fl. ac, Graph., Lach., Nit. ac, Ran. b., 

Sep., Sil., Sulph., Thuja. 

upper surface: Calc. c. 
Incipient or recent: Nat. c. 
Inflamed: Amm. carb. , x\rs.. Bell., Bovis. , Calc. c, 

Caust., Dulc, Hep., Lyco., Nat. c, Nitr. ac, Rhus 
t., Ruta, Sep., Staph., Sulph., Thuja. 

as if ulceration would set in: Hep. 
Inveterate or old: Calc. c, Caust., Cun., Ka. ca., 

Nat. m.,Nit. ac, Rhust., Sars., Sulph., Thuja. 

grow larger; Cun. 
Isolated: Calc. c, Caust., lyyco., Nat. c 
Jagged (cleft, divided or indented): Calc c, Caust., 

Euphr., L^'co. , Nit. ac, Pho. ac, Rhust., Sabi., 

Staph., Thuja. 

surrounded b}^ a hepatic areola, with bran-like 
desquamation: Lyco. 
Large or fleshy: Caust., Dulc, Ka. c, Lyco,, Nat. c, 

Nat.m., Nit. ac , Pho. ac, Rhust., Sabi., Sep., Sil., 

Thuja, Verrucinum. 
Malignant: Ars. 
Moisture, exuding: Calc c, Caust., Lj-co., Nitr. ac, 

Pho. ac, Rhus t., Sabi., Thuja. 

a fetid humor: Nitr. ac. 
Pedunculated: Caust., Dulc, Lyco., Medor.j Nit. ac, 

Pho. ac, Rhus t., Sep., Staph., Thuja. 

Small, all over the body: Caust. 

with pin-heads, like button mushrooms, on various 
parts of body and thighs: Medor. 
Recent or incipient: Nat. c 

Rough, upper surface whitish and horny: Calc. c 
Round: Calc. c 



312 SKIN DISEASES. 

Rudimentary, on fingers: Berb. 

Scrofulous: Aur. 

Seedy: Calc. c, Caust., Medor., Nat. m., Sep., Thuja. 

small: Bar. c, Berb., Calc. c, Caust., Cun., Dulc, 

Ferr., Ferr. ma,, Fl. ac, Hep., Lach., Medor., 

Nit. ac, Psor., Rhust., Sars., Sep., Sulph., Thuja. 
Smooth: Ant. cr., Dulc, Psor., Ruta. 
Soft: Alum., Ant. cr., Calc. c, Nit. ac, Thuja. 

at the base, almost the color of the skin; upper 
surface hard, rough, whitish and horny: Calc c 

with thin epidermis, and moist: Nit. ac. 

to touch, like lipoma and pointed, on neck: Thuja. 
Solid body, with horny top: Caust., Rhus t., Sep. 
Spongy: Alum. See soft. 
Suppurating (see Ulcerating): Ars., Bovista, Calc. c, 

Caust., Hep., Nat. c, Pho., Sil., Thuja. 

then healing: Calc. c 

a previously existing wart, developed a red point, 
suppurated and disappeared: Bovista. 

sensation as if they would suppurate; in the evening 
in bed: Petrol. 
Sycotic: Alum., Aur., Cinnab., Medor., Mil., Nat. 

sulph., Pho. ac, Sars. 

Old, dry; after mercurial treatment for gouty pains: 
Sars. 
Syphilitic: Aur., Cinnab., Ka. iod.. Thuja. 
Ulcerating (See Suppurating): Ars., Calc. c, Caust., 

Hep., Nat. c, Pho., Sil., Thuja. 
Ulcers breaking out around warts: Ant. cr., Ars., Nat. 

sulph., Pho. 

having the shape of warts: Ars. 

orignating in warts: Thuja. 

turning into warts: Calc. c. 



VERRUCA, OR WARTvS. 313 

Subjective Symptoms. 

Burning: Amm. carb., Ars., Ivyco., Nit. ac, Petrol., 

Pho., Rhus t., Sep., Sulph., Thuja. 
Itching: Calc. c, Carb. a.. Kuphr. , Hep., Ka. carb., 

Nit. ac, Pho., Psor., Sep., Sulph., Thuja. 
Painful: Ars , Amm. carb.. Ant. cr.,Bar. c, Bovis., 
Calc. c, Caust., Con., Euphr., Hep., Ka. carb., 
Lyco., Nat. carb., Nat. mur., Nit. ac, Petrol., Pho., 
Rhus t., Sabi., Sep., Sil, Staph., Sulph., Thuja, 
ameliorated on the appearance of menses: Thuja, 
preventing rest at night: Ars. 
like a boil: Calc. c 
cutting: Nat. mur. 

drawing, in an old w. on upper lip: Con. 
pricking: Ant. cr. , Calc c, Lyco., Nit. ac, Pe- 
trol., Rhus tox., Sep., Sil., Sulph. 
in the evening in bed: Petrol, 
pulsating (beating or throbbing): Ars., Calc. c, 
Caust., Hep., Ka. carb., Lyco., Nit. ac. Petrol., 
Sep., Sil., Sulph. 
shooting: Ars., Bovis. 
with pains, sticking: Hep., Nit. ac. 

stinging: Amm. carb., Ant. cr.. Bar. c, Calc. c, 
Caust., Euphr., Hep., Lyco., Nitr. ac, Rhus t., 
Sep., Sil., Staph., Sulph., Thuja, 
as if ulceration would set in: Hep. 
tearing: Amm. carb. 
throbbing: See pulsating. 

extending up the arm to the axilla, from a malig- 
nant wart on the hand, rendering the arm use- 
less: Ars. 
Soreness of: Ambra, Ars., Hep., Lach., Nat. carb., 

Nat. mur., Nit. ac, Petrol., Ruta, Sabi., Thuja. 
Tickling (see itching): Sulph., Thuja. 

21 



314 SKIN DISEASES. 

Condylomata, mercury; after the abuse of: Aur. , Lyco., 
Nit. ac, Staph, 
women, particularly in: Merc, d., Sabi. 

I.OCALITY. 

Anus, upon or about: Aur., Aur. m., Benz. ac.> 
Euphr., Lyco., Merc, c, Merc, d.. Mil., Nit. ac, 
Sabi., Sep., Staph., Sil., Thuja, 
a growth, like a w. , a quarter of an inch in height, 
and as thick as a pea, painless, itching, opening 
at the top and suppurating, in the ridge, close 
to the anus, lasting four weeks and gradually 
healed: Thuja. 
Clitoris, upon or about: Thuja. 
Eyebrows, upon or about: Thuja. 

Eyelids, upon or about; either on the internal or exter- 
nal surface: Cinnab,, Nit. ac. , Thuja, 
upon or about, lower: Nit. ac. 
Frsenum, upon or about: Cinnab. 

upon or about, oozing, especially during new moon: 
Thuja. 
Genitals, upon or about: Alum., Benz. ac, Lyco., 
Medor., Thuja. 

upon or about, female: Merc d.. Thuja. 
Iris, upon or about: Cinnab., Merc sol,. Thuja. 
Labium, upon or about: Sulph., Thuja. 
Larynx, upon or about: Merc c, Nit. ac, Thuja. 
Mouth, upon or about (inner): Phos. ac 
Neck, upon or about: Nit. ac. 

Penis, upon or about: Ant. t., Aur., Aur. m., Cinnab., 
Ka. iod., Ka. mur.. Lye, Merc c, Nit. ac, Nux 
v., Pho. ac, Psor., Sabi., Sanic, Sep., Staph., 
Sulph., Thuja. 

glans: Ant. t., Cinnab., Ka. iod., Ka. mur., Lyco., 
Nit. ac, Nux v., Pho. ac, Sanic, Staph., Sulph., 
Thuja. 



VERRUCA, OR WARTS. 315 

Corona glandes, upon; after chancre: Ka. mur. 

around: Aur. 

upon and behind: Staph. 

surrounding: Sep. 
Prepuce, upon: Aur., Aur. m., Cinnab., lyyco., Nux 

vom., Merc, c, Nit. ac, Sabi., Thuja. 

edge of, itching and burning: Psor. 
Perineum, upon: Merc, d., Thuja. 
Scrotum, upon: Aur. m., Thuja. 
Tongue, upon: Aur. mur. 
Uterus, upon: Lach. 

cervix: Kreos. , Merc, sol.. Nit. ac, Tarent., Thuja. 

os: Calc. c. , Kreos., Merc. sol. 

vagina, in: Medor., Nit. ac. , Pho. , Tarent., Thuja. 

vulva, upon: Merc. d. 

Objectively Considered. 

Bleeding: Arg. n., Medor., Nit. ac, Sulph., Thuja. 
Broad: Ac. ac, Kuphr., Merc, d., Nit. ac, Thuja. 
Bulbous: Alum. 

Cauliflower or mulberry like: Staph., Thuja. 
Chancre, complicated with: Arg. n., Cinnab., Ka. 

bichr., Merc, sol., Nat. sulph., Nit. ac, Pho. ac, 

Staph., Thuja. 

after: Kali iod. 
Cock's comb shape: Euphr., Staph., Sulph. 
Conical: Ka. mur., Merc, v., Thuja. 
Dry: Ac. ac, Cinnab., I^yco., Merc c, Merc, v.. 

Nit. ac, Sars., Staph., Thuja. 
Fan-shaped: Cinnab., Thuja. 
Filiform: Staph. 

Flat: Ac. ac, Euphr., Nit. ac, Sars., Sulph., Thuja. 
Gonorrhoea, complicated with: Cinnab., Con., Ka. 



316 SKIN DISEASES. 

mur., Lyco. , Merc, c, Nit. ac, Pic. ac, Puis., 
Sars., Sulph., Thuja. 
Moist ( discharging ) : Ac. ac. , Benz ac, Calc. c, 
Euphr., Graph., Hep., Ka. iod., lyyco., Medor., 
Merc, d., Nat. sulph.. Nit. ac, Psor., Sanic, Staph., 
Sulph., Thuja. 

discharging profuse: Benz. ac, Medor. 
greenish: Nat. sulph. 
offensive: Medor., Merc, d.. Nit. ac. 
smelling like fish-brine: Sanic 

herring-brine: Calc c, Graph., Hep., Thuja, 
old cheese: Calc c. Hep., Thuja, 
yellow fluid: Medorrh. 
Moon, worse with the increase of the: Thuja. 
Mulberry or cauliflower like: Staph., Thuja. 
Old, long standing, in cachectic subjects: Ka. iod. 
Pedicles, growing on. See pedunculated. 
Pedunculated: Lyco., Nit. ac, Sabi., Staph. 
Soft and spongy: Alum., Nat. sulph., Sulph. 
SpHt: Lyco., Nit. ac, Thuja. 
Strawberry-like: Medor. 

Suppurating (see Moist): Ka. iod.. Nit. ac. Thuja. 
Tubular: Thuja. 
Ulcers elevated, which have the appearance as if w. 

would grow out of them: Cinnab. 
Wart-shaped: Benz. ac. Nit. ac, Nux vom., Sars., 

Sulph., Thuja. 
White: Lyco. 

Subjectively. 

Burning: Kuphr., Pho. ac, Psor., Merc, d., Sabi. 

when touched: Euphr., Sabi. 
Itching: Cinnab., Euphr., Phyt., Psor., Sabi., Thuja. 

especially when walking: Euphr. 
about the joints: Cinnab. 







Ichthyosis. 



ICHTHYOSIS. 317 

Painful: Euphr., Sabi., Thuja. 

even when free from contact: Sabi. 
Painless: Lyco. 

Pain in bones or bone pains, with: Pho. ac. 
Sore; Euphr., Sabi., Thuja. 

when touched: Euphr., Thuja. 
Stinging: Thuja. 
Stitches in: Euphr. 

especially when walking: Euphr. 

Ichthyosis. 

Ichthyosis is a chronic disease of the skin, in which the 
epidermis is developed in excessive accumulations, usually 
accompanied by more or less hypertrophy of the papillae, 
presenting a dry, harsh, and "scaly" surface, whence 
its name, and arising from a congenital or hereditary pre- 
disposition in the patient. 

This disease is usually divided into two forms, ac- 
cording to the degree of development. 

The mild form, called simplex, is more frequently 
found, and varies from a very mild xerodermatous to a 
decidedly scaly condition of the skin. 

The severe form, called hystrix, shows its most ad- 
vanced stage, with the papillae enlarged and the cones 
betweefi extended and capped with horny excrescences of 
various sizes and shapes. 

While the characteristics of this disease are marked, 
particularly the objective symptoms, the subjective 
symptoms are almost entirely lacking. 

Ichthyosis Simplex. 

In this, the mild form, the skin of a new born infant is 
free from any apparent symptoms. It is usually not 
until after the lapse of a few weeks or months, and some- 



318 SKIN DISEASES. 

times years, that the disease is sujSiciently advanced to 
attract attention, when there is first noticed a dry, rough 
condition of the skin; its color, however, remains un- 
affected. The skin may be generally involved, or the 
affection may be confined to certain localities, such as 
the extensor surfaces of the limbs, and afterward extend 
over the whole surface of the body. By gradual devel- 
opment, the epidermis becomes slightlj^ thickened, and 
the natural lines of the skin begin to deepen, and those 
become apparent which ordinarily can not be seen. In 
its further development the epidemic scales become larger 
and more abundant. The scales enlarge in area and 
thickness, their outline being limited and conforming to 
the natural lines and furrows of the skin, and form plates 
of various shapes; those on the extensor surfaces of the 
extremities are the largest and resemble the scales of a 
fish. The well-developed scales are detached about their 
edges, but are quite firmly attached in their centres, and 
can be removed with little difficulty without abrading the 
surface of the papillae beneath, and blood following, as is 
the case in psoriasis. When the scales are thin and the 
skin kept clean, they present a white or pearly appear- 
ance. When more developed and thickened, this color is 
deepened, shading from yellowish to darkish-green or 
even brown or blackish. This is due partly to pigmen- 
tary deposits in the plates, but mainly to accumulations 
and incorporations of extraneous matter not removable 
by washing. Fissures or cracks are formed on the sur- 
face where it is thickest and most unyielding; but they 
extend only through the upper layer of the skin, and re- 
main dry, thus differing from those found in eczema, 
which extend deeper, giving exit to a serous discharge 
which dries into crusts. The anidrotic or dryish state 
of the skin, so markedly shown here, is probably due to 



ICHTHYOSIS HYSTRIX. 319 

a sparse and defective development of the sweat glands 

and follicles and to their functional inactivity in the 

parts affected; the unaffected parts remaining in the 
normal state. 

Ichthyosis Hystrix. 

This form is the more severe and rare manifestation of 
the disease, and presents a variety of developments. It 
is characterized by the excessive growth and accumula- 
tion of epidermis in the form of thick, irregularl}^ shaped, 
variously colored, horny masses, which admit of being 
detached, exposing a dr}^ and rough surface; or by more 
marked hypertrophied papillary growths which are sur- 
mounted by variously sized and shaped horny projections. 

In some instances they take the semblance of the 
quills of the porcupine; hence the name, hystrix. Its 
distribution may extend irregularly over various parts of 
the body, or may be localized in one or more well-defined 
patches, as, for instance, about the axillary folds, the 
knees, elbows, neck, or other regions. This form is also 
of gradual growth, is the most advanced, and its degree 
of development increases with age. 

The eruption is particularly severe and annojdng in 
winter, and sometimes diminishes in summer, recurring 
again the succeeding winter. 

Course. — The disease is progressive as age increases, 
until the climax is reached, usually at adult age, where- 
after there is little change. A spontaneous cure has 
rarely, if ever, occurred. The two varieties of the 
disease may occur together. 

Diagnosis. — Ichthyosis is so distinctly characterized as 
to render its diagnosis eas}^ and certain. In its mild form 
it is to be differentiated from xeroderma, meaning dry 
skin, which properly refers to a condition not ichthyotic 



320 SKIN DISEASES. 

in origin; from eczema, by the absence of pruritus; and 
from all other inflammatory disorders which tend to 
desquamation, by the absence of previous inflammation. 

Prognosis. — The simplex form may often be amelior- 
ated; but the hystrix form is rarely, if ever, more than 
temporarily improved. The general health is apparently 
unimpaired in either case; and there are instances where 
the mild form has decreased in development with 
increasing years; but it is a question if the disease once 
developed ever disappears or is cured radically. 

Etiology. — Ichthyosis is an hereditary affection, and 
usually transmitted in the line of sex; but there are 
man}^ exceptions to this rule, and numerous instances of 
the crossing of the sex. It is common to find several 
instances in the same family. 

Treatment. — This disease is seldom, if ever, radically 
cured, but the condition of the patient can be consider- 
ably bettered. The general health is apparently 
unaffected. The treatment should be directed to the 
relief of the symptoms present. The anidrotic condition 
of the skin may be improved by the employment of such 
agents as will increase the sweat-secretion. For this 
purpose the old school recommend jaborandi, in the form 
of fluid extract, taken daily, in drachm-dOvSes, and they 
claim that in some instances it has prompt effect, and at 
the same time loosening of the epidermic scales occur. 
The wet-pack has also been advantageously employed, or 
frequent washing and alkaline or other baths may be 
substituted with success for this purpose. After the 
removal of the epidermic accumulations, the newly 
exposed epidermis should be kept 'as soft and pliable as 
possible, by inunctions of some bland oil, to prevent a 
return to its former condition. Such treatment will 
afford relief, more or less permanent. 



ICHTHYOSIS HYSTRIX. 321 

A generous diet should be allowed the patient. 

An infusion of quillaya saponaris bark sometimes works 
well as a local fomentation. 

Internal homoeopathic remedies are: 

Arsen. iod. — Dry scaly skin ; itching and burning 
in scrofulous subjects with swelling of the lymphatic 
glands. 

Clematis. — When there are fine scales wnth some itch- 
ing, worse when getting warm in bed; painful swelling 
and induration of the glands. Eruption changes charac- 
ter with the changes of the moon. 

Graphites. — Skin dry and inclined to crack; unhealthy 
skin; every injury tends to ulceration; thick and crippled 
toe nails; extremities go to sleep; itching of the genitals. 

Iodine. — The skin has a brown dingy color; ravenous 
hunger; swelling and distension of the abdomen; emacia- 
tion in dark-complexioned, scrofulous children. 

Mercurius. — Dirty, yellow color of the skin; itching, 
worse at night when warm in bed; dry, scaly spots; in 
syphilitic and scrofulous subjects. 

Natrum carb. — Skin of the whole body becomes dry, 
rough and cracked here and there; frequent empty or 
sour eructations; great prostration. 

Phosphorus. — Skin is dry and wrinkled; skin of hands 
is rough and dry; pains in the chest; desire for acids and 
spicy foods; falling of the hair; great indisposition; in 
tall, slender people. 

Potassium iodide. — Skin dried up; rough, like hog skin; 
sensitive swelling of the thyroid gland; oedematous in- 
filtration of the tissues; after mercury or syphilis. 

Plumbum. — Dry skin; absolute lack of perspiration; 
obstinate constipation; paralytic weakness of the limbs. 

Thuja. — Dirty, gray, cadaverous looking skin. Wart- 



322 SKIN DISEASES. 

shaped excrescences; brittle or soft nails; lymphatic 
temperament. 

Hypertrophic Diseases of the Corium. 

Under this head are included all those diseases in which 
the fibrous tissue of the skin is in excess, and in which 
the disease extends to or involves the subjacent cellular 
tissue. These may be termed Jibro- cellular hyperplasicE . 
They are: Morphoea; scleroderma; keloid; fibroma; bue- 
nemia tropica; and dermatolysis. 

Morphoea. 

Morphoea, formerly called Addison's keloid, is a chronic 
cutaneous affection, characterized by the appearance of 
one or more discrete spots or patches, usually isolated and 
roundish in form, pinkish in color, and slightly elevated 
when hypersemic and hypertrophic, surrounded by a 
tinted or violaceous border, later becoming whitish, 
anaemic, atrophic, and slightly depressed; and upon 
their surface, in the early stage, may be seen small 
streaks of dilated blood-vessels. 

Forms. — This rather infrequent affection assumes 
various definite forms, according as the character of its 
development is mainly hypertrophic or atrophic. 

Patches of the first form, which are mainly hyper- 
trophic, enlarge until they are of the size of small or 
large coins, and are roundish in outline; after a prelimi- 
nary hypersemic stage, they gradually assume a lardaceous 
appearance, and later on show a distinct atrophic aspect. 

Lesions of the second form, which is mainly atrophic, 
manifest little or no tendency to hyperplasia, and occur 
in small, pit-like, or slightly depressed, cicatriform or 
telangiectasia, isolated or grouped spots or steaks, form- 
ing 7no,culcB et striiE atrophicce. 



MORPHCEA. 323 

Symptoms. — A typical case of morphoea usually 
makes its appearance by the formation of one or more 
roundish, circumscribed, hyperaemic, slightly elevated 
macules or patches, varying in diameter from one-quarter 
to a couple of inches; the centre gradually whitens, and 
is bordered by a tinted circle of violaceous or pinkish hue, 
composed of dilated capillaries, and often there is to be seen 
a plexus of small blood-vessels extending upon the surface 
of the lesion. The hyperaemia of the patch is soon suc- 
ceeded by an anaemic state, which may be sometimes so 
decided as to cause a slight depression of the surface. 
The patch, from this time, undergoes a gradual change 
until it presents the characteristic smooth, lardaceous ap- 
pearance, resembling inlaid wax, or old ivory. The con- 
nective tissue of the skin is increased and becomes con- 
densed. The activity of its process of development 
becomes lessened during this stage of the disease and 
enters on a chronic course. The skin of the patch may 
be soft, or quite firm and inelastic. 

In its further progress the affection may manifest 
atrophic changes in the tissues as well as of the glands 
and vessels of the affected skin, resulting in contraction 
and also depression of its surface, together with a lessen- 
ing or cessation of the secretions of the sweat and 
sebaceous glands; and the skin feels stretched and 
thinned. These later changes may extend over a 
period of years and become permanent, or the affection, 
before it has become decidedly atrophic, sometimes dis- 
plays its tendency to recovery by the disappearance of 
the lesion. 

The distribution of the lesions is asymmetrical, and 
has been found upon various regions of the body, as upon 
the face, chest, back, buttocks, arms, and thighs. The 
shape of the patches, even in individual cases, is 



324 SKIN DISEASES. 

irregular, and varies, being round or elongated, but 
usually roundish. 

In its early stage, morphoea develops usually without 
any or with but slight attending subjective symptoms; 
later there may be more or less anaesthesia. 

Diagnosis. — In its advanced stage, morphoea is so 
characterized that its diagnosis is readily made. Some- 
times, however, it is so very like scleroderma that it is 
difficult to differentiate between them. 

In scleroderma the patches are usually symmetrically 
distributed, and the affected skin is hide-bound, or can 
not be lifted up into a fold by the fingers, and feels hard. 
In morphoea the patches are asymmetrically distributed, 
and the affected skin feels soft or firm. 

In scleroderma the patches are not circumscribed, but 
show a tendency to spread over a large surface, and at 
their border merge indistinctly and gradually into the 
surrounding skin. In morphoea the patches are often 
distinctly circumscribed, and confined to a limited area; 
and in their earlj^ stage are surrounded with a tinted 
border of pinkish or lilac hue, or the surrounding healthy 
skin is more or less pigmented. 

When the pigmentless spots in vitiligo resemble the 
whitish spots of morphoea, it is only to be remembered that 
the former is due simply to the absence of pigment, while 
the latter is caused by an abnormal state of structure, and 
of vascular supply. 

Patches of morphoea sometimes present appearances 
very similar to those of anaesthetic leprosy. The ob- 
jective and subjective symptoms in the progress of these 
diseases are so different as to render the diagnosis be- 
tween them certain. 

Prognosis. — The prognosis of the disease is, to a cer- 
tain extent, favorable, but depends largely on the degree 



SCLERODERMA. 325 

of development, particularly if it has not yet become 
atrophic. In this latter condition the lesions are lasting; 
but in its earlier stage, and especially when there is only 
moderate hypertrophic change in the connective tissue, 
there is a tendency to spontaneous disappearance. 

Its course of development, when mainly hypertrophic, 
is quite short, as compared with the period elapsed dur- 
ing the atrophic stage, which is usually slow and chronic, 
extending over several years. 

Etiology. — The cause of this disease is yet to be de- 
termined. From what is known concerning the func- 
tional disturbances and trophic changes that occur in the 
development of its lesions, and their appearances in the 
hypertrophic and atrophic stages, the disease is thought 
to be due to some disorder of the nervous system, and 
probably of tropho-neurotic nature. Its occurrence has 
been noted mostly in females, and is at times attended 
with symptoms of more or less nervous debility. Sclero- 
derma, in some essential respects, resembles morphoea, 
and inferentially is very likely of a similar origin. 
Indeed, some view morphcea as merely a localized form of 
scleroderma. 

Treatment. — In the treatment of this disease, locally, 
some mild stimulant may be applied, as a mercurial 
preparation, and electricity to promote resolution. 
Phosphorated oil inunctions are beneficial. The patient 
should be well-fed, and have a daily allowance of either 
cod-liver or chaulmoogra oil. 

Phosphorus is the principal internal remedy. 

Scleroderma. 

Scleroderma is a chronic circumscribed affection of the 
skin, appearing on almost any part of the body, having 
I been observed on the face, neck, upper and lower 



326 SKIN DISEASES. 

extremities and elsewhere. It commences with slowly- 
forming infiltration, apparently permeating the entire 
thickness of the skin, with slight elevation of the affected 
area. The color is slightly heightened, with a brownish 
red tint. At the same time the integument becomes 
matted to the underlying connective tissue and fasciae, 
and so tightly bound down to them that no motion of the 
skin over them is possible, resembling scleriasis in this 
respect. This condition remains for a varying period, 
with constant tendency to spread, usually in the form of 
a band. Thus, when it commences on one of the lower 
extremities, for instance, it slowly progresses upward, 
involving a breadth of integument equally perhaps one- 
fourth or one- third of the circumference of the limb. 
After a time the other limb, or one of the arms, may 
become involved. As the disease progresses, however, 
the parts first involved undergo a change. The infiltra- 
tion subsides, and gradually reveals the fact that the 
normal connective tissue of the skin has in part dis- 
appeared. In other words, marked atrophy is manifest. 
The skin, however, has not loosened its hold on the 
underlying tissues, and still remains as firmly bound 
down to them as ever. 

The affection is accompanied with very little pain or 
other local inconvenience, except so far as it interferes 
with the free action of the joints and muscles. 

The diagnosis of scleroderma is not difificult, as the 
hide-bound condition above described is met with in but 
one other affection, namely, scleriasis. The history of 
the invasion and the course of the affection should be 
sufficient to enable it to be distinguished from Morphoea. 

The prognosis of scleroderma varies. In some cases it 
may continue for many years without apparently com- 
promising the general health, while in others its progress 



SCLERIASIS. 327 

may be more rapid, and possibly be the exciting cause of 
visceral troubles that ultimately prove fatal. 

Treatment. — There are no drugs known to the old 
school which, given internally or applied externally, 
influence the progress of the disease in the slightest 
degree. 

Frictions, massage, and the constant galvanic current, 
however, will sometimes result in very marked improve- 
ment in the condition of the affected parts. 

Antini. crud.^ Alumina, Berberis, Causticuin, Mer- 
curius, Pulsatilla, Rhus tox., and Sulphu?' may often be 
of service. 

Scleriasis. 

Scleriasisis an acute affection of the skin, characterized 
by the sudden development of a curious scleroid condition 
over an extensive surface. In a few days the greater 
part of the integument of the chest, abdomen, or back 
ma3^ without change of color or any inflammatory symp- 
toms, become rigid and firmly bound down to the tissues 
beneath. It appears to have absolutely lOvSt its elasticity, 
and to be so firmly attached that it is as impossible to 
raise or pinch it up in folds as it would be to pinch up 
paint or varnish from a board. 

This condition ma}^ exist in varying extent and of 
varying degrees of severity for several weeks, when a 
gradual return to the normal may ensue. 

The prognosis is good, as the cases usually recover. 

The etiology is obscure, but the affection is probably 
of rheumatic origin. 

Treatment. — Little need be done in the way of special 
treatment, but proper attention should be given to the 
correction of any marked impairment of the general 
health. Turkish baths and massage, with or without 



328 SKIN DISEASES. 

electricity, appear to shorten the course of the affection. 
As internal remedies Hydrocotyle, Phos. , and Stillingia 
may be thought of. 

Sclerema Neonatorum. 

This is an affection of the skin met with in new-born 
infants, in which the greater part of the integument may 
become rapidly involved in a process which results in a 
generahzed hide-bound condition, which interferes with 
motion of the limbs, and even restricts the action of the 
thoracic muscles. A fatal termination is usually to be 
looked for in a few days. 

The nature of the disease is obscure — in fact, its exact 
etiolog}^ is unknown; but its general features point to a 
close relationship to the affection described as scleriasis, 
as met with in adults — the better prognosis in this latter 
disease being due to the greater resisting powers of the 
adult. 

Treatment, other than sustaining, appears to be of lit- 
tle avail. 

Keloid. 

Keloid is characterized by the growth upon the skin of 
one or more rounded or oval, flat, smooth-surfaced 
tumors of varying size, from the margins of which irreg- 
ular projections are frequently met with. 

The development and progress of the affection is 
chronic, and is attended with but little pain or other in- 
convenience. The color of the skin is in some cases little 
changed, while in others it becomes paler and even com- 
pletely blanched, like that of ordinary scar tissue. 

,The affection is said to arise spontaneously, and at 
other times at the site of some traumatism or wound of 
the skin; and the terms true and false keloid have 



KELOID. 329 

been applied to these two forms, which are to be distin- 
guished only by their etiolog3^ 

Vidal reports the case of a 53 year old man in whom 
a keloid, nine centimetres long, three centimetres wide 
and one centimetre high, developed spontaneously in the 
sternal region. He did not have syphilis and no discov- 
erable cause could be found. At first it increased in 
size, but slowly; since 1878, however, it grew more 
rapidly and became painful. A second keloid has lately 
developed in the flexure of the right elbow, also without 
visible cause. 

We know, however, that keloid may arise from even 
the minutest wounding of the skin, as from the prick of 
a pin or lancet point. 

Amicus reports the case of a young nervous woman 
who, from childhood, suffered from nervous symptoms. 
One year before coming under his observation she was 
attacked with a symmetrical eruption on the trunk and 
lower extremities, showing 318 keloids, the size of millet 
seeds. The lymphatics were normal; the urine showed 
nothing wrong. During her sojourn in the hospital she 
had several convulsions, retention of urine, etc. These 
so-called keloids were small pinkish elevations on the 
skin, which might be mistaken for sarcomata. No 
trauma preceded the trouble. 

Mr. Hutchinson mentions some rare forms of keloid, 
in which he details several interesting cases, with the fol- 
lowing conclusions: 

1. That with keloid, as with other skin diseases, we 
must not expect too close a conformity to the type form. 

2. That for clinical convenience, we may recognize 
^, several varieties of keloid, the prognosis as to sponta- 
,neous disappearance and proneness to return after ex- 
1 cision differing much in each. 

22 



330 SKIN DISEASES. 

3. That the first and most typical is that in which 
keloid begins in very small, perhaps forgotten, scars, and 
slowly spreads far beyond their limits into sound skin. 
In most cases, the extension and duration are indefinite; 
and the hardness, glossiness, abruptness of outline, etc. , 
are always well marked. The proneness to recur very 
quick! 3^ after excision is very great in these. 

4. That in the second group, in which keloid growth 
begins in the middle of large scars, such as those of 
burns, it is seldom so well characterized. It often does 
not extend beyond the scar, and often, especially in 
young persons, soon begins to soften again, and to grad- 
ually disappear. 

5. That in a third form the keloid growth is deeper, 
never produces the glossy, superficial, elevated, and 
spurred patches which occur in the others. These cases 
are very slow, and show but little tendency to spontan- 
neous disappearance. They do not develop in connection 
with large scars, but rather with inflammatory damage 
to the skin. They are less prone than the others to 
recur after excision. 

6. That although definite scars almost invariably pre- 
cede the formation of keloid, yet that there are allied 
conditions which result rather from inflammation after 
injury, than from anything which is demonstrable as 
cicatrix. 

7. That the cases of multiple keloid prove either that 
there is in some persons a remarkable tendency to the 
disease, or that primary patches have the power of in- 
fecting the blood and producing others. 

8. That there is little or no clinical proof of tendency 
on the part of keloid to pass into cancer. 

The etiology of keloid is unknown, and we can only say 
that some individuals possess a certain peculiarity or 



FIBROMA. 331 

idiosyncracy that leads to the development of this curious 
affection. 

Treatment. — Excision, cauterization, potential caus- 
tics, whether alkaline or acid, when of suflSicient power 
to rapidly destroy the tumor, are almost invariably fol- 
lowed by relapse and often in an aggravated form. Re- 
lief sometimes follows scarifications followed by the 
application of acetic acid. The operation should be per- 
formed a number of times, according to the size, etc., of 
the tumor. In cases of excessive keloidal growth, ex- 
cision may be employed as a means of temporary relief. 

Several cases are recorded where electricity has been 
employed with excellent results. 

Fluoric acid is the principal internal remedy, and the 
next is Graphites. Nitric acid and Sabina are occasionally 
indicated. 

Dr. Neatly reports a number of cases as cured by the 
persistent use of Silicea for a few months. 

Fibroma. 

This name is applied to tumors of varied size and form, 
which take their origin from the dermal or sub-dermal 
tissues, which are single or multiple, and vary in size 
from a small nodule to a tumor of many pounds' weight. 
These tumors may be sessile or pedunculated. 

The affection is chronic, taking years for its complete 
development, but the growths are usually painless, and 
give little or no inconvenience, except such as may arise 
from their size or particular location. 

The causes of fibroma are unknown, but they are of 
perhaps more frequent occurrence in mulattoes than in 
either the pure white or black races. 

Diagnosis. — Fibromata are to be distinguished from 
sarcomata and neuromata, and this may be readily done 



332 SKIN DISEASES. 

when we remember that the former are of more rapid 
growth, and exhibit changes in the color and texture of 
the skin, which in fibroma are unaffected. Neuromata 
are usually painful. The diagnosis must be made in the 
early stage from sebaceous cysts; in the case of cysts, 
the origin from a flat gland, the central aperture or en- 
trance to it, and the fatty contents which can be squeezed 
out, determine the nature of the disease. The hard con- 
tractile sessile outgrowths of keloid could not well be 
mistaken for the lax, flabby, pedunculated tumors of 
fibroma, which have the aspect of normal integument. 

Treatment. — Piffard says: ''Excision is the only 
practicable method of treatment, and this is to be recom- 
mended only when the tumors are few in number, or 
when their situation demands it. ' ' 

Fox says the treatment is simple: '' When small, 
fibromata may be removed. In elderly men they are 
sometimes small, flat, and numerous — especially about 
the back, over the shoulders, and on the chest. I have 
never had the least trouble in getting rid of them all by 
the use of acid nitrate of mercury caustic to the smaller, 
and the joint use of that remedy and the ligature to the 
larger ones. I generally, after applying the acid, give 
an oxide of zinc paste to be used, to prevent too much 
irritation." 

The Arsenzte of calcarea and Lycopodium are the princi- 
pal internal remedies. 

There is yet another form of fibrous hypertrophy, in 
which greater laxity of tissue is observed. It is called — 

Dermatolysis. 

In this affection the skin hangs in loose folds. Its 
fibro-cellular element is greatly increased. The affection 
really includes all pendulous conditions, from obesity, 



. 



ELEPHANTIASIS. 333 

parturition, the state of skin in lax and enlarged mammse, 
and the like. In the uncomplicated form of disease, the 
hypertrophic growth arranges itself in layers like the 
folds of a tippet; there is little vascularity; the sensibility 
of the past is diminished. 

Elephantiasis. 

This affection is characterized by great hypertrophy 
of the integument of either the leg or scrotum in men, or 
leg or labia in women, or both locations may be involved 
at the same time. It occurs frequently in tropical coun- 
tries, but rarely in northern climes. 

In the development of this disease general symptoms 
precede the local ones, and the first indications are 
usually a sharp, febrile attack, in no way distinguishable 
at the beginning from an ordinary severe paludal fever. 
In a few days, however, pain in the groin, with swelling of 
the lymphatics, is noticed, and this in turn is followed by 
more or less oedema of the foot and leg. After the subsi- 
dence of the febrile attack the oedema of the limb abates, but 
does not as a rule wholly subside. After a varying and 
uncertain interval a second febrile attack occurs, with re- 
newed sw^elling of the limb, which but partially subsides, 
leaving the part still a little larger than before. These at- 
tacks succeed each other irregularly several years, until 
finally the leg or other part affected may attain an enor- 
mous size. 

Elephantiasis is unquestionably due to obstruction of 
the lymphatic circulation; and this in turn has been 
most conclusively proved in many cases to be due to the 
presence of a minute worm, the filaria sanguinis, which 
lodges and excites inflammation in the lymphatic glands 
and produces occlusion of the vessels. The febrile 
attacks, which occur with a certain periodicity, may be 



334 SKIN DISEASES. 

due to the development of fresh broods oi filaria. This 
parasite, however, is not met with in the higher latitudes, 
in which cases of the disease are sometimes encountered; 
and hence these latter need some other reasonable ex- 
planation, which we regret to say is not forthcoming. 
It is supposed by some that the mosquito plays an im- 
portant part in the development and transportation of 
the undeveloped filarise. 

Elephantiasis is always a grave disease, and may last a 
life time. 

Treatment. — A milk diet is the best for the elephan- 
tiasis patient, and if it is a possible thing a change of 
climate should be made. 

I can not recommend Esmarch's bandage, neither 
amputation, as I have never seen any benefit from either 
expedient. 

Relief, and occasionally beneficial results, come from 
the use of hamamelis or chaulmoogra oil dressings. 

Myristica sebifera is the main internal remedy. Hy- 
drocotyle Asiatica^ has been recommended, as have also 
Anacardium orientale and Elceis guineensis. 

Milium. 

This name is given to an affection characterized by the 
appearance of minute white or pearly papules. 

These little papules are usually clustered about the 
eyes, sometimes on the upper and the lower lids, and 
often on tbe cheeks just below the eyes. They cor- 
respond to sebaceous glands, of which the orifices have in 
some manner become occluded, thus allowing an accu- 
mulation of sebum. They are much more frequently 
met with in women than in men. 

Treatment. — Milia are readily removed by dividing 
the thin skin that retains them with a sharp curved 



MAMMILLITIS MALIGNA. 335 

needle ground flat on the curve. A little pressure is 
exerted, and the tiny white sebous concretion rolls out. 
The Calcium iod. is the principal remed}^ and the next 
Staphysagria. Tabaciim may be thought of. 

Mammillitis Maligna. 

Under this designation we embrace the peculiar and 
rare disease of the nipple and areola, commonly known as 
"'Paget's disease of the nipple." 

Dr. James Paget was the first to describe this disease, 
and he states that he had seen some fifteen cases, all oc- 
curring in women between the ages of forty and sixty. 
The affection commences as a red, almost raw inflamma- 
tory condition, confined to the mammilla and surround- 
ing areola; the surface being somewhat granular, and 
looking not unlike an ordinary eczema rubrum from 
which the epithelium had exfoliated, and accompanied 
with a very similar exudation, with some tingling, burn- 
ing, and itching. In other words, it presented the ordi- 
nary appearances of a common eczema, except that, 
when taken between the fingers, there was a firmness of 
the tissues, approaching the condition of induration, that 
is never met with in eczema proper. 

The chief peculiarities of this disease, however, are the 
facts that, first, it is exceedingly rebellious to treatment, 
obstinately refusing to heal under the simple measures 
that would suffice in ordinary eczema; and, second, that 
the disease in question proves to be a forerunner of car- 
cinoma. 

It is on this fact that the real importance of the disease 
depends, as in the beginning it gives rise to very little 
local or other inconvenience. 

Treatment. — If the diagnosis is firmly established, 
extirpation, either by the knife or caustic, is the only 



336 SKIN DISEASES. 

means of treatment that promises any success, as sooth- 
ing remedies do not check its progress, while those of a 
stimulating nature simply aggravate the lesion. 

I am unable to recommend any homoeopathic remedy 
as having had any influence upon the disease. Kali 
mur. and Silicea might be tried, given in alternation. 

Ainhum. 

This disease consists of spontaneous amputation of 
the little toes, with hypertrophy of the amputated part. 
The name means " to saw." The disease is said to exist 
amongst the Africans. 

A small semi-circular furrow first appears in the digito- 
plantar fold, which gradually increases, without pain or 
inflammation, the toe enlarging, and getting loose and in 
the way. If the toe is cut off, the wound left heals very 
speedily. The cause is unknown. The general health 
does not suffer. The disease is symmetrical. The am- 
putated toe shows fatty change of the tissues, enlarge- 
ment of the areolar spaces of some of the bones of the 
phalanges, the bone tissue between the middle and 
proximal phalanges being replaced by fibrous tissue, the 
separation of the toe taking place at the proximal, 
inter-phalangeal joint, and not the metatarsal phalangeal 
joint; the cartilage and articular end of the middle 
phalanx being removed and replaced by fibrous tissue^ 
which looks like an ordinary cicatrix. 

Nsevus. 

These spots are congenital; and they are not only 
hardly ever amenable to surgical treatment, but have 
in many cases been rendered much worse by such inju- 
dicious treatment. Some remarkable nsevi reproduce 
upon the skin of the child while yet unborn the vivid 



N^vus. 337 

impression made upon the mind of the mother. An- 
other and more profound influence of the same kind, or 
one exerted in an earlier stage of pregnane}^, results in 
actual deformities and monstrosities. 

NcBvi materni may be arranged in three distinct classes, 
in the order of their gravity. 

1. Moles, the most common of all, whose character 
and harmlessness are well known, and which are gener- 
ally attributed to some alteration in the structure of the 
rete raucosum. 

2. Venous Aneurisms — Anastomosis of Venous CapiU 
laries. — These form a dark-red circumscribed stain, 
which generally appears on one side of the face, and is 
sometimes of considerable extent. These " marks," 
which appear to be simple dilatations of the sub-cuticular 
capillary vessels, may increase in extent till puberty, and 
then remain stationary. 

3. A?ieurisms and Dilatations of the Arterial Capil- 
laries — These form the most important of the naevi; they 
are apt to enlarge in after-life, especially when stimulated 
by external irritation, and they may give rise to danger- 
ous hemorrhage if improperl}^ meddled with. They form 
slightly elevated spots, with well-defined margin and a 
granular surface, which consists of an erectile vascular 
tissue. These granulated tumors, raised above the skin, 
may in fact be constituted of venous or of arterial vessels. 
In the former case they may be of a dark-blue or livid 
color; in the latter, of a brighter red. 

Treatment. — Mr. Thomas reports three cases treated 
b}^ collodion. The nsevi were covered, together with the 
surrounding skin, with collodion, which was repeatedly 
applied. Improvement was so marked as to do away with 
the necessity for operative interference. 

Dr. Mayor publishes an interesting case of a nsevus of 



338 SKIN DISEASES. 

the cutaneo-subcutaneous variety, on the back, in a girl 
aged ten months, where he successfully tried electrolysis. 
The number of sittings was two, and the duration of each 
about two minutes. On examination of the patient, 
nearly four years later, not a trace of the naevus was 
detected. 

Dr. Marshall, from an experience of many years, 
recommends the electrolytic treatment of naevi as superior 
to every other. After criticising the methods in vogue, 
he claims for electrolysis: That it gives no after-pain; 
that it is free from danger; that there is no bleeding; 
that the resulting scar is white and shows no tendency to 
contract — a point not to be forgotten since nsevi are so 
common about the head and face. This method is slow, 
the disappearance being gradual. One or more needles 
are used according to the size of the growth, and they 
are moved about to attack the various portions without 
withdrawing them. It is well, at first, to work well 
away from the surface to avoid destroying the same. The 
scars left by the negative needles are apt to be brown and 
disfiguring and hence the positive pole is to be preferred, 
being slower in its action, less apt to cause sloughing or 
to be followed by bleeding after withdrawal of the needle, 
A rheophore attached to the negative pole completes the 
circuit, a second puncture being thus avoided. As re- 
gards the number of cells, ten are usually sufiicient, 
although in deep nsevi as many as twenty have been 
used. A change in color to a dusky hue is the indica- 
tion to stop the current. To withdraw the needle it 
should be first rotated and the orifice can be painted with 
collodion. 

The following remedies should be carefully studied, in 
order to find the simile in each case: This being found, it 
should be given sufficiently high and at long intervals, in 



N^vus. 339 

order to remove as rapidly as possible from the system 
the morbid condition which sustains these irregularities 
of the circulation, and to enable nature to remedy the 
deficiency in structural organization from which perhaps 
they originally sprung. 

If the arterial capillaries are involved: 

Bellad. will be indicated by red radii extending from 
the centre. 

Calc. carb. — In leucophlegmatic temperaments. 

Lycopod. — In hypertrophied capillary tumors, both 
venous and arterial. 

If the venous capillaries are hivolved : 

Carbo veg. — Particularly when the slightest irritation 
causes free hemorrhage. 

Phos. — Small wounds bleed much; this may be either 
venous or arterial. 

Dr. Wilkinson reports a case of naevus on left labium 
majus, little girl aged six weeks, cured by application of 
thuja 6>, thrice daily for six weeks. 



CHAPTER XIV. 

NEW FORMATIONS, OR NEOPLASMATA. 

Neoplasmata are essentially characterized by the for- 
mation of new kinds of tissue in the skin. Neoplasms 
are observed in many different diseases of the skin, and 
under a variety of circumstances, but those diseases only 
are included in this chapter in which a neoplasm forms 
the entire disease. The new tissue in neoplasms has 
been regarded as originating in, and therefore an hyper- 
trophy of, already existing elements; but it is certainly 
not a pure hypertrophy, and it is new in regard to its 
characters and behavior. On this account it is impossi- 
ble to include the neoplasmata in any but a special 
group. 

Lupus. 

There are three principal forms of this disease — the 
superficial variety, commonly spoken of as lupus erythe- 
matosus ; the deeper, or lupus vulgaris ; and the deeply 
destructive form, or lupus exedens. 

These three varieties present certain features in com- 
mon, and their color is peculiar. It is neither the frank 
red of an active congestion nor the brownish ham-color 
of syphilis, but rather the vinous color that derives its 
hue from chronic venous congestion; mingled with a 
certain amount of red. The lesions are few in number; 
often but a single lesion may be present, but quite fre- 
quently we may find two or three — rarely more. Their 
course is chronic, years being devoted to their develop- 



LUPUS ERYTHEMATOSUS. 341 

ment. They almost always leave scars, even in the 
absence of ulceration. The local symptoms are insignifi- 
cant, as there is rarely either pain or itching, at most a 
slight burning sensation, to which the patient becomes 
habituated and ceases to notice. In the patient's family 
history, pulmonary phthisis is an almost constant feature. 
Several years ago Bazin and Hardy gave the name of 
scrofidides to these affections, recognizing at that time 
their dependence on the general constitutional condition 
that predisposes to tuberculosis. Quite recently, the 
bacillus tuberculosis has been found to be a constant ac- 
companiment of the lesions, thus demonstrating the 
soundness of the opinions advanced by the eminent der- 
matologists above mentioned. 

Lupus Erythematosus. 

In this variety the lesion commences as a reddish 
macule, barely elevated above the level of the surround- 
ing skin. As it slowly but gradually increases in size, 
the elevation slightly increases, and small, closely ad- 
herent scales form upon the surface. The extension is 
peripheral, and after many months, or perhaps years, may 
attain the size of a coin. When it has reached a 
diameter of, say, one-half to three-quarters of an inch, the 
central and older portions begin to lose their infiltrated 
character, sink to the level of and even beneath the level 
of the skin, at the same time losing their color. This 
continues until we find a white depressed scar, sur- 
rounded by a still infiltrated raised reddened ring. Dur- 
ing the progress of the lesion as described, other similar 
ones may have appeared on neighboring or on distant 
parts; but, as a rule, their number is limited. When 
two patches have appeared in close proximity, the}^ may 
join by mutual peripheral extension. In this way the 



342 SKIN DISEASES. 

greater portion of one side, or even both sides, of the 
face may become involved by the disease. Such ex- 
tensive invasion, however, is the result of years, as cases 
are met with in which the lesions have been gradually 
extending in this manner for twenty years or more, the 
older portions of the lesion undergoing the retrogressive 
changes we have noticed. 

The favorite seat of all varieties of lupus is the face, 
although other parts may be attacked as well, and even 
to the exclusion of the face. 

Epithelioma may develop upon the site of a long- 
existing erythematous lupus, or in the neighborhood of 
lupous lesions. 

Lupus Vulgaris. 

L. vulgaris is characterized by the development of 
tubercles within or projecting to a greater or less degree 
above the surface of the skin. It rarely appears as an 
isolated tubercle, but more frequently in groups of six or 
a dozen tubercles, quite close to, but not touching one 
another, little bands of apparently healthy skin inter- 
vening, thus forming a patch. As the disease progresses, 
however, the tubercles may unite by mutual extension 
and the entire patch present a lupous character. There 
may be one or more of these patches. The tubercles 
themselves are soft, sometimes almost jelly-like, in 
appearance and consistence. The extension of the lesions 
is slow, years intervening before the patches attain any 
notable size. 

Just as in the erythematous variety, the lesions of 
lupus vulgaris may undergo resolution, leaving a 
depressed cicatrix, or else they may ulcerate superficially. 
The ulcerative action is exceedingly slow, and appears to 
involve only the upper portion of the derm — more rarely 



, LUPUS EXEDENS. 343 

its entire thickness. The exudation from the surface of 
the ulcer is exceedingly scanty, and forms a crust 
adhering somewhat closely to the sore. The scars that 
result are of a reticulate character, not unlike those 
produced by a severe burn, and naturally cause more or 
less disfigurement. Lupus vulgaris, after ulceration 
takes place, may be succeeded by epithelioma at the 
margins of the ulcer. 

Lupus Exedens. 

This form of lupus was recognized by all the older 
writers; but those of recent times seem disposed to deny 
it a place in nosology, or declare that the cases described 
under this name were not lupus at all, but were epithe- 
liomata. This is not in accord with Dr. Piffard's 
observations, and he describes in this place a variety of 
lupus characterized by the development of usually a 
single good-sized soft tubercle. This slowly increases in 
size, until after a lapse of years, perhaps, ulceration sets 
in, which extends both in width and depth, involving the 
tissues beneath the skin. The margins of the ulcer are 
uneven, ragged, and burrowed under. The edges, 
however, are soft, not presenting any hardness or indura- 
tion. After an indefinite period, however, at one or more 
points on the periphery of the ulcer hard nodules may 
and usually do develop, and which can easily recognize 
as unmistakable epithelioma. This epitheliomatous pro- 
cess may extend until the greater part of the ulcer is 
involved. The only contention concerning the nature of 
this disease is whether it is a true epithelioma from the 
beginning, or whether it is an epithelioma ingrafted on a 
lupous basis. Whatever may be the true pathology of 
the disease, the practical outcome is the same, and this is 



344 SKIN DISEASES. 

usually a fatal termination, unless the lesions be early 
vigorously dealt with. 

Lupus may occur in the throat, and may make its 
appearance at any time of life. It occurs in men oftener 
than in women. It may occur in any constitution but 
seems to prefer the lymphatic temperament. Inheritance 
has nothing to do with it. Sometimes the mucous 
membrane assumes a purplish color, swells up and 
becomes granular and one or two of the granulations 
develop so much as to reach the size of a pea, or even 
that of a hazel-nut. Occasionally, the tubercles become 
prominent in the throat previous to alteration in the 
mucous membrane, and without differing from its normal 
color. They may be either superficial or deep. Their 
surface is smooth and brilliant, but if several of them 
become intimately united they appear as a single mass, 
rounded, cloven, and anfractuous. When the tubercles 
develop exuberantly in the larynx, breathing becomes 
embarrassed, and even stridulous. There is no alteration 
in the sensitiveness of the affected parts. Finally, the 
tubercles soften and become ulcerated. This melting 
down does not take place in a complete manner. In 
some cases, only the surface of the tumor becomes 
fissured or excavated as a margin to simple excoriations. 
In others, the destructive process attacks a greater or 
smaller portion of the tubercle in its entire depth, 
producing ulcers which dip out of sight in the midst of 
the tissues. The cure of these cases is difficult and is 
followed by indelible scars. In some cases, the ulcers are 
developed in a slow but fatal manner; in others, they 
spread with astonishing rapidity; while in some others, 
they stop in the beginning, but how far their ravages may 
extend it is impossible to predict. 

Instead of appearing in its usual idiopathic form, 



LUPUS EXEDENS. 345 

lupus, at times, develops subsequent to other skin lesions, 
for instance, a traumatism. In such cases it affects one 
or more localities, but always where formerly an injury, 
ulceration or scar has been. 

If the disease attacks the fingers it can completely de- 
stroy thern, but never the nails or the matrix. As the 
finger is shortened by the disease the nail maintains its 
position at the end of the stump, and may finally reach a 
position over the head of the metacarpal bone, where it 
remains in apparently as healthy a condition as in its nor- 
mal condition. 

The family history of the great majority of patients 
suffering from lupus reveals the important fact that 
phthisis pulmonaris is met among the near relations to a 
surprising extent, and we are forced to the conclusion 
that the same constitutional condition that predisposes 
one subject to the invasion of tuberculosis of the lungs 
predisposes another to tuberculosis of the skin; but the 
exact role played by the tubercle bacillus is no more 
known to us in the one case than in the other. 

The diagnosis of lupus is in general easy. When we 
consider the location of the disease, the color of the 
lesions, their slow development, the absence of sub- 
jective symptoms, the presence of citatrices in cases of 
long standing, and the repeated relapses after even vigor- 
ous attempts at treatment, we ought not to be often led 
astray. A question may sometimes arise as to whether 
certain tubercles or ulcerations are lupous or syphilitic. 
The length of time they have existed will usuall}^ settle 
this, when we remember that syphilitic lesions may reach 
a degree of development in a few weeks that might 
hardl}^ be accomplished b}^ lupus in years. The single 
tubercle of lupus exedens is to be distinguished from 
sarcoma and epithelioma. In sarcoma the development 
23 



346 SKIN DISEASES. 

of the lesion is much more rapid, while in epithelioma, 
the tubercle is hard, but in lupus exedens it is soft. 

In no disease of the skin is the prognosis more de- 
pendent on the character of the treatment. In early 
cases it is absolutely good if sufficiently vigorous treat- 
ment be instituted, while lack of appreciation or lack of 
vigor on the part of the physician is responsible for most 
of the extensive and long-standing cases that we meet 
with. 

Treatment. — Lupus erythematosus may sometimes be 
cured by the induction of an artificial eruption produced 
by the action of irritants. This method, however, is not 
to be commended. It is much better to destroy it with 
an active caustic, provided the extent of the eruption 
does not contra-indicate this method. When the lesion 
is quite small, excision may be practiced; or thorough 
scraping with the dermal curette, followed by nitric acid, 
or the actual cautery. lyUpus vulgaris demands the same 
treatment as the other form. In lupus exedens 
thorough removal with the knife of the diseased portions, 
including a portion of the surrounding apparently 
healthy tissue, is the better plan. 

Dr. Mackay reports two cases of lupus healed after a 
few weeks of treatment by a twenty per cent, ointment 
of resorcin, applied after scarification. The application 
of resorcin was attended with but comparatively little 
pain. 

Sulphurous acid, in the form of a lotion, or an oil, or 
in the gaseous state, has been employed as a remedial 
agent in lupus. The gaseous form may readily be ob- 
tained by burning in a jar, and allowing the fumes free 
contact with the surface to be treated. This can only be 
used upon parts removed from the respiratory organs. 
As a rule, two applications daily, each for about twenty 



LUPUS EXEDENS. 347 

minutes, will be found best. The lotion is best obtained 
by the use of the pharmacopoeical preparation of the 
acid, diluted in strengths of one in two, or one in three. 
This can be applied to any part of the face without pro- 
ducing disagreeable effects. The oil is preferred by some, 
and is prepared b}' dissolving the anhydrous acid in cas- 
tor or olive oil. Satisfactory results frequently follow 
this method of treatment. 

Alveloz has latel}' been recommended as a local appli- 
cation for lupus and cancer. Cases have been reported 
where brilliant cures were effected by the use of the 
drug. I have had no opportunity of testing its virtues. 

The application of ice will frequently relieve the severe 
pain that is sometimes the accompaniment of lupus; 
some authors claim curative effects from the use of ice. 

Arsenicum alb. and Hydrocotyle, are the main internal 
remedies. 

Others ma}^ be indicated as follows: 

Aurum miir. — When starting from the nasal mucous 
membrane; a discharge from the nares very offensive; 
absorptiori of the bones of the nose; melancholia. 

Cishis. — Lupus on the face; worse from cold air. 

Graphites. — Lupus on the nose; obstruction of the 
nares; dry, cracked skin; every injury tends to ulcera- 
tion. 

Guarana. — Lupus of an ochre-red color, yellow spots 
on the temples. 

Hepar. — Lupus on the elbows; ulcers with burning or 
stinging edges; nodosities on the head sore to the touch; 
swelling of the upper lip. 

Hydrastis. — Ulcers on the legs; exfoliation of the 
skin; purulent discharge from the nostrils; faint, sinking 
feeling at the stomach. 

Kali bichrom. — Ulcers painful to the touch; worse in 



348 SKIN DISEASES. 

cold weather; ulceration of the nasal septum; loss of 
appetite; all the secretions are tenacious and stringy. 

Lycopod. — In recent cases; hunger with constant feeling 
of satiety; arms and fingers go to sleep easily; purulent 
discharge from the ears; weakness of memory; melan- 
cholia. 

Nitric ac. — Lupus on the nodules of the ears; offensive 
purulent discharge from the ears; dry, scaly skin; affec- 
tions of the bones and glands; in dark complexions. 

Oleum jec. ass. — A valuable remedy. 

Staphysagria. — Ulcers on the alse of the nose; weary 
pains in the limbs as if bruised; teeth turn black and 
decay; in scrofulous subjects. 

Epithelioma. 

Epithelioma, or epithelial cancer of the skin, is character- 
ized by the appearance of a hard tubercle or nodule, 
slowly increasing in size until ulceration sets in, which 
ulceration may extend both laterally and deeply and 
destroy all tissues with which it comes in contact. As 
its name implies, it is an outgrowth from the epithelial 
tissues, in which a more or less extensive and exuberant 
proliferation of epithelial cells occurs. The typical 
epithelioma may be said to take its origin in the 
Malpighian layer, the cells of which increase in number 
and seek accommodation in the deeper layers of the skin. 
As they increase, however, some of them, from the 
pressure of the neighboring connective tissue, are forced 
to occupy a smaller space than they would if permitted 
to multiply freely in all directions. As a result of this 
compression, small rounded bodies are formed, in which 
the cells assume a stratified arrangement, constituting 
the epithelial cell-nests well-known to every microscopical 
observer. Coincident with this extension of the disease 



ii 



EPITHELIOMA. 349 

inward there is a greater or less projection outward, 
forming a distinct sessile tubercle, or a more flattened 
growth. 

Primary cancer of the skin is a rare condition, while 
■epithelioma, involving both cutaneous and mucous sur- 
faces — as ordinary cancer of the lip — is sufiiciently com- 
mon. Cancer of the skin, however, w^hich has developed 
secondarily to some pre-existing morbid growth, is the 
variety most frequently found in practice. 

Epithelioma is distinctly the product of irritation — not 
an acute and transient irritation, even if frequently re- 
peated, but rather one that is hardly, if at all, appreciable 
to the senses, and which is persistent and active through 
a lengthened period. Thus we may find that a purely 
innocent and benign growth, like a simple wart, may 
after a lapse of years become the seat of an epithelioma, 
which would not otherwise have appeared. A localized 
seborrhoeic condition, which of itself implies an irritation 
of the epithelial lining of the glands, may, and not infre- 
quently does, become the starting point of cancer. 
Lupus offers an inviting field for the development of the 
disease; and in general it may be said that an ulcerating 
lupus, if left to itself, will almost invariably in time be- 
come supplanted by epithelioma. Sarcoma more rarely 
is followed by epithelioma, and this rarity may be ex- 
plained by the fact that sarcoma usually runs its course 
and has destroyed the patient before the cancerous af- 
fection has had time to develop — the irritation produced 
"by the sarcoma being more active than that w^hich ordi- 
narily leads to the occurrence of the other disease. 

Epithelioma is met wdth clinically in two distinct forms, 
in one of which the cutaneous involvement is more 
superficial than in the other. In the superficial variety, 
■which is less frequently met with than the other, the 



350 SKIN DISEASES. 

patient's attention is first attracted to a little crust — 
usually on some part of the face. This he picks off, and 
gives little further attention to the matter. A new crust 
forms, and this is in turn picked off, and reveals, per- 
haps, a slightly excoriated surface. He consults a phy- 
sician, who, failing to recognize the gravity of the condi- 
tion, prescribes some salve or other, or lightly touches 
the part with caustic. The lesion extends, and perhaps 
rarely reaches the hands of a surgeon until it has ad- 
vanced to the stage of frank ulceration. We now find a 
sharp-cut ulcer, extending through the entire thickness 
of the skin, but not involving the subcutaneous tissues. 
This ulceration advances at its borders, or sometimes in 
one direction only, while reparative changes may some- 
times occur in the other, much after the manner of some 
cases of lupus. The progress of the ulceration is exceed- 
ingly tardy, and years may elapse before the ulcer has 
attained any considerable size, and, when it does, we will 
sometimes find that cicatricial tissue now occupies a por- 
tion of the territory that had been the early seat of the 
cancerous lesion. 

The other, or tuberous form of epithelioma, will be 
recognized at the beginning as a hard tubercle, occupy- 
ing the seat of what may have been previously the situa- 
tion of a wart, mole, etc. This tubercle increases in size^ 
and the tissues beneath it are palpably involved in the 
morbid process. The skin surrounding the tubercle is 
also involved to a certain, or, rather, uncertain extent, 
as is evident to sight and touch. Later, ulceration ap- 
pears, and the margins of the ulcer are everted and hard. 
As the ulcer spreads laterally, so also does it become 
deeper, and the process continuing unchecked leads in 
time to a fatal termination. 

The diagnosis of epithelioma, when actually existing. 



EPITHELIOMA. 351 

is surrounded with very few difi&culties as the induration of 
the tissues is hardly to be met with in any other chronic 
cutaneous lesion; but the physician should be prepared 
as well to recognize conditions which will probably 
become epitheliomatous in time. It is this failure to 
diagnosticate an impending epithelioma that leads more 
frequently than it should to inefficient treatment and the 
sacrifice of lives that might otherwise have been saved. 
The face is the most frequent seat of purely cutaneous 
epitheliomata; and, if a physician can not make up his 
mind as to whether a certain hard tubercle or a chronic 
ulceration is cancerous or not, his plain duty is to take 
his patient to some one who can. 

The prognosis of cutaneous epithelioma is good, 
provided the lesion is seen in its early stages, and its 
locality permits of suitable and efficient local treatment. 
On the other hand, it is distinctly dad if the disease has 
gained much headway or involves an extensive surface. 

The treatment of epithelioma will depend, firstly, on 
W'hether the particular lesion in question is, or is not, in a 
curable condition. This is in realitj^ the most serious 
question that the surgeon has to determine, and to its 
solution he should bring his best judgment, based on his 
knowledge and experience. If he decides that it is 
incurable, any operation would be a barbarity, and 
suggestive of charlantry; but if there is a good prospect 
for the thorough removal of the neoplasm, no time should 
be lost in carrying it into effect. 

The removal of epitheliomata may be effected in two 
ways. One of these is with the knife, and, when this is 
practicable, it is the best way; and there is but one rule 
to follow — cut widely and cut deeply. If for any reason 
the knife is impracticable, the diseased tissues may be 
destroyed by a sufficiently active chemical agent; and 



352 SKIN DISEASES. 

experience has shown that arsenic properly used is 
probably the most efficient means at our command. Now, 
there are two ways of using arsenic; one is to use it 
strong enough to destroy the cancer; and the other is to 
use a weaker preparation and destroy your patient by 
arsenical poisoning. The stronger the arsenial preparation 
the greater its local action; while the weaker it is, the 
less is its topical action, and the greater the probability 
of systemic absorption. Take anhydrous chloride of zinc 
and mix it with an equal weight of water — to this add 
sufficient arsenic to make a moderately stiff paste. This 
should be applied to the diseased parts in a reasonably 
thick layer with a little absorbent cotton as a top dressing. 
To this treatment there is one objection, namely, the 
severe pain that the arsenic will cause, which can only be 
mitigated by the free use of morphine. If the lesion be 
of moderate size, and the application thorough, the 
falling slough will, in a week or two, reveal a healthy 
ulcer, which only requires a little time for complete 
healing. 

If the case has progressed beyond the period when a 
cure may reasonably be expected, the prudent surgeon 
will seek only to mitigate the patient's sufferings until 
death brings its release. 

Resorin grammes 30. 

Vaseline, " 100, applied daily, has cured some 

cases that were diagnosed as epithelioma. The parts 
were first cleansed with borax water. 

Aristol has been successfully used as a topical applica- 
tion. 

Its advantages over arsenic are its painlessness, and 
rapidity of action. 

Thuja is the principal internal remedy. Other 
remedies are: Sepia ^ Ars. alb. (malignant form), Con- 



il 



SARCOMA. 353 

durango. Lapis alba. Nitric acid.: A roundish ulcer, 
bluish-red and nodulated; bleeds upon slightest touch; 
burning pain which becomes almost unbearable, when 
eating or drinking, when touched by cold or warm food. 

Hoang nan. — Attacking especially the mucous surfaces. 

Petroleu7?i. — Nodules on hands, wrists, arms, feet and 
legs; worse about wrists or wherever the dress is tight 
(palms and soles being free), less on face, neck and parts 
to which oily matters find access. Pimples itching on 
angle between scrotum and thigh, scabs in fold of left 
wing of nose. 

Sarcoma. 

The word literally means a fleshy tumor, and embraces 
in its scope a varity of new growths, which present 
certain common features, but which differ, however, 
among themselves in many essential particulars, both as 
to form and constitution. 

In general, it may be stated that a sarcoma is a tumor 
composed in the main, of cellular tissues, the cells them- 
selves being either round or fusiform, and partaking of the 
characters of embryonic rather than fully organized adult 
tissue. The new growth is usually exceedingly 
vascular, being permeated with large vessels, some of 
which are doubtless extensions from pre-existing vessels of 
the neighboring parts, while others are doubtless first 
and independently formed in the new growth itself, and 
connect themselves later with the older vessels. In some 
instances there is a considerable deposit of pigmentary 
particles, probably derived from the blood coloring 
matter throughout the growth. These histological 
changes give rise to three types of tumor — namely, the 
round-cell sarcoma, in which the round cells greatly 
predominate over the fusiform; the spindle-cell sarcoma. 



354 SKIN DISEASES. 

in which these cells make up the greater part of the 
growth; and, thirdly, the melano or pigment-sarcoma, 
which may resemble either of the addition of the 
foregoing with the addition of the pigmentary deposit. 
As a rule, neither of these types is met with in its purity, 
the majority of sarcomata being of a mixed type, with 
one or the other greatly predominating. 

The earliest noticeable lesion of sarcoma may be a 
macule or a tubercle. The macule may develop into a 
tubercle, or, on the other hand, may vSpread laterally in 
the skin, forming a patch or blotch one, two, or more 
inches in diameter. These patches are heightened in 
color, the hue being a bluish-brown, are hardly at all 
elevated, and differ in consistence but little from the 
surrounding integument. In fact, they appear to be 
patches of chronic congestion rather than infiltration. 
The evolution of the macules is tardy, and a year or more 
ma}^ be occupied before they attain any considerable size. 
It is possible that these macules may exist singly, but they 
are usually multiple. These macules may undergo com- 
plete resolution, and leave little trace of their previous ex- 
istence. Under these circumstances the propriety of 
classing them as a variety or lesion of sarcoma might be 
seriously questioned were it not for the fact that they 
not infrequently become the starting-point of typical sar- 
comatous growths. After the macule has attained a cer- 
tain size, an elevation at one point occurs, developing 
into a tubercle and ultimately into a tumor. 

The primary tubercle of sarcoma may develop at the 
site of some long-standing innocent growth, as a mole, 
etc., or may take its origin in apparently normal skin. 
The former is the more usual course in persons advanced 
in years, while the latter is commonly the case in children 
and young persons. 



SARCOMA. 355 

The progress of sarcoma is usually rapid, and a tubercle 
in a few weeks may deserve the title of tumor, and after 
the lapse of some months may attain the size of a child's 
head or even larger. 

The sarcomatous tubercles and tumors present one 
character which is in striking contrast with carcinomatous 
growth. I allude to their consistency. Sarcomata are 
soft, sometimes of almost jelly-like consistence, w^hile car- 
cinomata are hard. 

After sarcomata have attained a certain size, they 
usually soften in the more central and older portions, and 
break down, forming a fungoid ulcer, from the base and 
edges of w^hich secondary sarcomata may spring. Occa- 
sionally the margin of the ulcer becomes epitheliomatous. 

No age is exempt from the development of sarcoma, 
but it is decidedl}^ more frequent before the age of fifteen 
and after forty-five than during the intermediate period. 
When w^e compare the three most important tumor 
types — namely, carcinoma, fibroma, and sarcoma — we 
are struck with their peculiarities and contrasts. Carcin- 
oma is especialh^ prone to occur late in life; it is a 
malignant growth, composed of tissue elements w^hich are 
little viable, and do not form permanent tissue, but ulti- 
mateh^ break down with ulceration. Fibroma, on the 
other hand, prefers the middle period of life, is benign, 
and is composed of viable and permanent tissue; while 
sarcoma, as we have seen, prefers the extremes of life, 
and is malignant, its elements not going to the formation 
of permanent tissue. 

Sarcoma may be characterized by the development of 
either single or multiple tumors. When single and not 
interfered with they may attain a considerable size. 
When multiple the tumors vary in size from that of a pea 
to that of a hen's egg. 



356 SKIN DISEASES. 

Hemorrhages accompany advanced cancerous disease, 
but they are insignificant compared with those which 
may occur in sarcoma. The extreme vascularity of the 
new growth and^ the unsubstantial character of the ves- 
sel's walls are sufficient to account for this pronounced 
hemorrhagic feature, which is met with not only in old 
and advanced tumors, but even in those that are small 
and have had but a few weeks' growth. 

Sarcomata may appear on any portion of the integu- 
ment, and exhibit little preference for any particular 
location, and after they have existed for some time are 
liable to develop on the mucous membranes, and also in- 
vade the viscera. 

The general health and vigor may be apparently un- 
impaired during the early periods of the existence of 
sarcoma; but as the disease advances, these gradually 
fail, but without, however, the development oi a cachexia^ 
as marked as in the latter stages of cancer. 

The prognosis of sarcoma varies. In single small 
tumors of recent appearance it is good, as they can be 
easily removed; and when the operation is properly per- 
formed they do not as a rule return. When sarcoma be- 
comes generalized the prognosis is unfavorable, and this 
is specially the case when complicated with melanosis. 
Large sarcomatous tumors are usually fatal. 

Treatment. — Beyond attention to the general health, 
there need be little expected from internal treatment, 
although there are undoubted cases of sarcoma on record 
in which the homoeopathic remedy exerted a favorable in- 
fluence and apparently effected a cure. 

In small and young single sarcomata mechanical re- 
moval should be effected just as soon as a diagnosis is 
established, care being taken to remove a considerable 
portion of the apparently healthy skin, and the location 



CARCINOMA. 357 

of the tumor will permit. Special provision should be 
made against hemorrhage, which, from the large number 
and size of vessels entering the tumor, may be excessive. 
In very large sarcomata, in which an ultimate fatal 
termination is to be anticipated, removal is hardly to be 
recommended, except as a palliative measure, looking 
only to temporary relief. In these cases removal by 
means of a loop of platinum ware heated by electricity 
is to be preferred to the knife, on the score of safety from 
hemorrhage. 

Carcinoma. 

The carcinomatous family of malignant tumors con- 
tain the tumors which the term cancer, as understood at 
the present day, is properly applied. A carcinoma is a 
tumor made up of a typical epithelial new formation-cells, 
of epithelial origin, but imperfect embryonic cells. 
Structurally it consists of cavernous, fibrous stroma, in 
the interspaces or alveoli of which are found the epithe- 
lial cells suspended in a serous fluid. The cells are not 
separated by any visible intercellular substance. Even 
the blood vessels run in the fibrous stroma and not be- 
tween the cells. 

The development of cancer from epithelium has been 
clearly shown in certain localities where morbid processes 
are taking place. Some years ago, Paget called atten- 
tion to the point that a certain eczema of the nipple is 
often the precursor of cancer. In cases of this kind, it has 
been showm that the proliferation of cells which is active 
over the denuded portions is continued down into the 
milk ducts until these ducts have become filled and ex- 
panded by the over-accumulation of imperfectly formed 
cells. At the same time, the connective tissue surround- 
ing the duct takes on an increased vascularity from the 



358 SKIN DISEASES. 

irritation, and is infiltrated with small cells resembling 
leucocytes. There is no direct connection between the 
cells of the duct and those found in the connective tissues 
outside. The latter are not migrating epithelial cells, 
but appear as the product of inflammation. As the ducts 
become filled and their walls distended, they give way, 
and the epithelial cells infiltrate into the surrounding 
tissues where they proliferate and become centres of 
disease. 

It is believed by some pathologists that the entire 
growth is not due to the proliferation of epithelium, al- 
though originating in this way. Endothelial cells, con- 
nective tissue cells, and indifferent corpuscles in the pres- 
ence of, or by contact with, a growing carcinoma, it is 
claimed, become infected and transformed into cells simi- 
lar to those of the tumor itself. While this may be true, 
the progress of carcinoma in its extension to the lymphatic 
glands does not support this theory, for instead of in- 
fecting and transforming the gland as a whole, the mode 
of invasion is between and around the lymph corpuscles, 
they being affected only by the pressure of the rapidly 
growing masses. As the cells increase and distend the con- 
nective-tissue spaces the fibrous tissues are pressed back 
and welded together, and the stroma of the cancer makes 
its appearance. The stroma is not real cancerous tissue, 
but the natural tissue of the part is sometimes increased 
by unnatural activity of the surrounding tissue. The 
blood-vessels of the stroma, like the fibrous tissue, in- 
crease in size, so that the stroma becomes much more 
vascular than the original fibrous tissue. 

Scheurlen claims to have obtained by cultivation from 
the juice of cancer of the breast in sterilized plural fluid, 
colonies of bacilli and spores, the bacilli being from, i 3m. 
to 2.5m. in length. By inoculating six dogs, in the 



CARCINOMA. 359 

posterior mammary glands, with an emulsion of these 
cultures he has demonstrated the appearance of cancerous 
tumors. Finally, he has found the spores, if not the bacilli 
in question, in all the preparations of cancer stained by 
Gram's method. His conclusions are as follows: i. 
There exist constantlj^ in cancerous tumors bacilli which 
may be isolated. 2. The spores of these bacilli are 
found in all microscopic preparations of cancerous tissue. 

3. Inoculation of animals with pure cultures of these 
bacilli determines the development of cancerous tumors. 

4. There is a relation of cause and effect between these 
bacilli and cancer. 

The female sex, on the whole, is much more exposed 
to cancer than the male, on account of the greater 
liability of the female organs of generation. The breast 
alone probably furnishes as many cases of carcinoma as 
all other portions of the body. 

Carcinoma is essentially a disease of old age. It is so 
rare before thirty years that the age is often the most 
important consideration in the early diagnosis between 
benign and malignant growths. After thirty years of 
age it becomes more frequent, but it is not until the acme 
of life is reached and the organs begin their natural retro- 
gression, that cancer becomes common. At, and after 
the climacteric in women, and at a somewhat later period 
in men, the cancer is most active. So well recognized is 
this fact that a tumor appearing at this time of life is 
always regarded with suspicion. Certain localities are 
attacked much earlier than others. In early adult life 
it is found most frequently in the testicle and labia; from 
thirty-five to fifty, in the breast, uterus, the tongue, and 
the penis; from fifty to sixty-five years, on the lip and 
oesophagus. It is a noticeable fact that the organs in 



360 SKIN DISEASES. 

which natural degeneracy of function takes place are the 
organs most frequently attacked. 

The carcinoma is a tumor of rapid growth. It never 
remains idle, and, with the exception to be noted, never 
decreases in size. In the manner of its extension, locally, 
it resembles sarcoma. 

The carcinoma is liable to many changes, but one of 
the most common features is the tendency to ulceration 
shown by the growth. 

The reproduction of cancer in an associated lymphatic 
gland is of such frequent occurrence that it is looked upon 
as one of the most certain signs of carcinoma. The 
glands affected are usually those having a direct ana- 
tomical connection with the affected part. Thus the 
axillary glands follow infection of the breast; the lym- 
phatics in the groin, carcinoma of the testicle; and the 
submaxillary or sublingual glands, infection of the 
tongue or lip. There seems to be no limit to the number 
of glands involved. From one to fifty have been found 
enlarged, varying all the way from the size of a pea to 
that of a walnut. 

The lungs, liver, etc., may become infected through 
metastatic deposits, carried thence by the blood. 

The chief forms of carcinoma are the schirrus, en- 
cephaloma, colloma,and melanoma. 

The schirrus is characterized by its firm, hard, dense 
feel, having a similarity, in this respect, to normal 
cartilage. It is most frequent of all the forms, and has 
been observed and recognized from the earliest times. 

The e?icephaloma is a soft tumor, and is the most 
malignant of all tumors. It occurs at an earlier age than 
the other forms of cancer, being almost the only one 
which is found before the age of puberty. To the touch, 
the tumor presents a peculiar soft feel, giving way under 



CARCINOMA. 361 

pressure, and returning to its shape again, as if filled 
with fluid. It varies in volume from the smallest kernel 
to a tumor of the size of an adult's head. 

The collorna is so called because it consists, in large 
part, of a clear, viscid, gelatine-like substance. 

The melayiotic cancer, is apparently an encephaloid 
cancer which has been changed in appearance by the 
deposition of a black pigment in the elements composing 
the growth. A noted peculiarity of melanosis of the 
integument is its pronounced tendency to form in or 
tinder a pigmentary mole. 

The diagnosis of the different forms of carcinoma, 
when located in some external part, is usually a matter of 
no great difficulty. 

The schirrus is generally found in the breast. It is a 
solitary tumor, and rarely appears before the forty-fifth 
year of age. In feel it is firm, hard, dense, resembling 
cartilage. It grows slowly, and never attains large size. 
From its start it is accompanied by sharp, shooting, 
lancinating pains, which are distinctly localized. It early 
contracts adhesions to the integument and deeper tissues. 
If in the breast, the nipple is retracted. The superficial 
veins are but slightly enlarged. Ulceration occurs early, 
and the ulcer has an abrupt, steep edge, and a firm hard 
base. The lymphatics are invaded at, or soon after, the 
beginning of ulceration. The diagnostic symptoms of 
schirrus are clear-cut and cannot be mistaken. 

The encephaloma may occur at any age and in almost 
any portion of the body. It is soft, lobulated, usually 
solitary. It grows rapidly, and often acquires a very 
large size. Pain is absent or slight until the advent of 
ulceration, when it becomes severe, but does not assume 
the lancinating character of the schirrus. The sub- 
cutaneous veins are always enlarged. Ulceration is early 
24 



362 SKIN DISEASES. 

and the ulcer is foul, with thin edges, and is often 
covered with a fungous, friable mass. The lymphatics 
are early involved. 

The colloid cancer is rare, and its characteristics are not 
pronounced. It is tardy in its growth, of uniform con- 
sistency, free from pain, and often attains an immense 
bulk. It is usually found in the peritoneal cavity; when 
superficial, it may be confounded with a fibrous or carti- 
laginous tumor or sarcoma. It is distinguished from 
fibroma by its more rapid growth, its large size, and its 
constitutional tendency; from chondroma by its elasticity 
and less firm feel, as well as by its more rapid progress; 
from sarcoma by its more uniform growth and compara- 
tively slow progress. 

The 7nelanotic cancer can only be distinguished by the 
peculiarity of its color and its frequent origin from pig- 
mentary moles. From the facts given in the diagnosis 
this may be deduced; a tumor appearing late in life, 
which grows rapidly, is attended with pain, infiltration of 
the surrounding tissues, and adhesions to the integument 
and tissues beneath, shows a marked tendency to ulcera- 
tion and to infection of the lymphatic glands, and decay 
of the vital forces, is a cancer or malignant tumor. 

The prognosis in carcinoma is exceedingly unfavorable/ 
the natural progress in every case being toward the de- 
struction of life. The prognosis, as to course and dura- 
tion of the disease, varies much in the different forms and 
in the different parts of the system affected. Scirrhous 
cancer is one of the most regular in its course, its average 
duration, when uninterrupted by operation, being about 
three years. 

The encephaloma is more rapid in its course, the aver- 
age duration of life being less than two years, even in 
parts whose formations are . not essential to life. Carci- 



I 



CARCINOMA. 363 

noma of the tongue, the interior of the month, the 
oesophagus, and the penis are very rapid in progress, 
being usuall}' fatal in from twelve to eighteen months. 
Carcinoma of the lip, the face, and the rectum are slower 
and more amenable to treatment. 

Treatment. — The treatment of cancer has always 
been extremely unsatisfactory. Various remedies have 
from time to time been heralded as cures, but after 
thorough trial have in every instance been discarded. 
Among these are: Chian turpentine; Resorcin; Inter- 
parenchymatous injections of ozone- water; Chromic acid; 
Cundurango bark, etc. Galvanism has been highly 
recommended, as has also the inoculation of the cancer 
with erysipelas. 

Occasionally, cures of cancer by the administration of 
homoeopathic remedies have been recorded, but the cases 
are so few, and the possibilities of error in diagnosis so 
many, that the value of these remedies in the treatment 
of this disease cannot but be called into question. There 
are many tumors, the result of acute or chronic inflam- 
matory action, which resemble very closely some of the 
forms of cancer. Many of these are amenable to the 
properly selected remedy, and it is cases of this character 
that have been cured by the remedy recorded. That no 
remedy has been discovered which is absolutely specific 
to the disease there can be no reason to doubt, but that 
remedies are of no value in the treatment of the disease 
cannot be so positively asserted. Whatever doubts may 
arise as to the value of remedies in overcoming the dis- 
ease when once aroused, there can be none as to service 
rendered by remedies in retarding the development of the 
disease and in relieving many of the accompanying symp- 
toms. At the close of this article will be found the 
remedies employed in the treatment of cancer. 



364 SKIN DISEASES. 

While remedies are of value in relieving many of the 
attendant symptoms of cancer, and are often curative 
in ulcerations and indurations resembling cancer, at the 
present day surgery offers the only possibility of a radical 
cure. In certain forms of cancer in which involvement 
of the lymphatics does not occur until late in the prog- 
ress of the disease, the possibility of cure following an 
operation is always greater than in those in which lym- 
phatic involvement is early noticed. 

Epitheliomas of the lower lip are quite amenable to 
treatment, the thorough removal of the tumor before the 
submaxillary gland becomes involved being, in many in- 
stances, followed by cure. Even in the more rapid and 
malignant scirrhous and encephaloid tumor, thorough 
removal gives a percentage of cures sufficiently large to 
encourage the belief that early and radical measures will 
succeed in materially reducing the mortality of the dis- 
ease. 

The removal of the disease, if it does not succeed in 
effecting a cure, is still a great benefit to the patient. A 
careful study of the statistics shows that the average 
duration of life is increased twelve months in cases oper- 
ated upon over those in which the disease proceeds un- 
molested by surgical measures. The increase in life in 
some cases is several years. Even if this hope cannot 
be entertained, an operation is often justifiable on the 
ground that it will avert the suffering attendant upon the 
regular progress of the disease. The relief which fol- 
lows an operation is sometimes remarkable. Freed of the 
local pain and offensive discharge, the patient will become 
cheerful, sleep, eat, and even gain in flesh. 

In those cases in which an operation is not advisable, 
much relief from pain and offensive odor may be ob- 
tained by the use of certain applications. The best of 



ij 



CARCINOMA. 365 

these is hydrochlorate of Cocaine. Painting the ulcerated 
surface with a two-to- four per cent, solution affords instant 
relief. When the discharge is profuse and offensive, the 
ulcer should be washed frequently with a strong solution 
of carbolic acid. Hyposulphite of soda may be used 
when other disinfectants fail. The surface of the ulcer 
is washed with a saturated solution added to an equal 
quantity of water, and lint steeped in the solution is laid 
upon it. The distressing night-sweats of the later stages 
of the disease may be controlled or improved by the use 
of aromatic sulphuric acid or aromatic vinegar. At this 
time also the use of morphine to allay pain and to secure 
sleep is permissible. It is best given by hypodermic in- 
jection. 

Therapeutical indications: 

Acetic acid. — Cancer of stomach, ulcerative gnawing 
pain at one spot in stomach with agony and depression, 
preventing sleep; severe burning pain in stomach and abdo- 
men, vomiting of yellow, j^eastlike matter, of blood; eyes 
sunken and surrounded by a dark circle; face pale and 
w^axen; tongue pale and flabby. 

Apis met. — Is indicated in cancer of the breast, in 
which the induration has followed an old case of mastitis^ 
and in which the pain is of a burning, stinging character. 
The characteristic urinary symptoms of the drug are the 
best indications for its use. 

Arsen. alb. — Foul, destructive, easily bleeding, and 
cancerous ulcers, with burning and corrosive pains in the 
interior of the affected parts; terrible darting and lanci- 
nating pains through them; burning discharges, which 
may be thick or thin, brown or black, extremely offen- 
sive; worse after midnight. 

Aurum. — The womb is prolapsed and indurated; pain 
like that of a bruise, with shooting and drawing, and the 



366 SKIN DISEASES. 

mind constantly dwells on suicide. Cancer of the palate 
and nasal bones, or of the nose; pus greenish, ichorous, 
and putrid; cancer of stomach in last stage, when there 
are only few subjective symptoms. 

Bellad. — Scirrhous indurations; cancerous ulcers, burn- 
ing when touched; black crust of blood in the bottom of 
the ulcer; pus scanty. Pains come and go suddenly. 

Carbo mi. — Cachexia fully developed. Scirrhous can- 
cer on the forehead; sudden and short aching from col- 
loid cancer in the pit of the stomach, on taking a deep 
inspiration, clawing and griping in stomach, violent 
pressing in loins, small of back and thighs during 
menses, with chilliness and yawning; weak empty feel- 
ing in the pit of the stomach; it checks the putrid taste, 
the waterbrash, and contracting, spasmodic burning; 
scirrhous mammae with dirty bluish loose, skin or red 
spots on skin, burning and drawing towards axilla; ax- 
illary glands indurated. 

Causticum. — Patient cannot bear the pressure of the 
clothes on the stomach; the lightest food or even the 
smallest quantity causes a violent lancinating pain in the 
stomach; scirrhus of the lips, with itching and soreness, 
which when ulcerated has a violent burning pain; pus 
bloody, or greenish, or corroding, or thin, watery, and 
yellow. 

Chelidoiimm. — Old, spreading, putrid, carcinomatous 
ulcers; the pain in the stomach is of a gnawing or digging 
character; nausea, with sensation of heat in the stomach; 
burning in stomach. 

Calcarea phos. — Cancer in scrofulous constitutions. 

Calcarea fluor . — Knots, kernels, hardened glands in the 
female breast. Swelling on the jaw bone which is hard. 

Chimaphila. — Tumors of the mammae, enlargements of 
lymphatic glands. 



CARCINOMA. 367 

Clematis. — For softened scirrhous uteri, with corrosive 
leucorrhcea and lancinating pains. 

Conium. — Bleeding of the ulcers, with a secretion of 
fetid ichor; a portion becomes gangrenous; concealed 
•cancer of bone; cancerous swelling and induration of 
glands; cancer of the lips; spreading cancerous ulcers in 
the face; contractive spasmodic pains in the stomach; 
cancer and cancerous ulcers after contusion; burning 
stitches; stinging in the affected parts. 

Cundurango . — Is onl}^ eflScacious in open cancer and 
cancerous ulcers, where it effectually moderates the 
-severit}^ of the pains. It does not act on scirrhous and in- 
durated parts. 

Femim phos. — An excellent alternate remedy for ex- 
cessive pain in cancer. 

Eucalyptus. — One of the best remedies for destroying 
the fetid odor of cancerous discharges, used internally 
and locally. 

Galium. — Epithelioma, when the disease is slow in its 
progress, and where there are nodular deposits near the 
surface. 

Graphites. — Hot and painful vagina; swelling of the 
lymphatic vessels and mucous follicles; the neck of the 
uterus is hard and swollen, with tuberculous 7iodes and 
cauliflower excrescences; great weight in the abdomen on 
rising, with fainting sort of weakness and aggravations 
of the pains, delaying menses, with aggravation of the 
pains shortly before and at the appearance of the menses; 
discharge of black, lumpy, fetid blood; stitches shooting 
through the abdomen as far as the thighs; buryiing and 
stitching pains; constipation; livid complexion; sad and 
anxious mood. Frequently useful in connection with 
ovarian diseases. 

Hepar. — Corrosive pain in a cancerous ulcer, bleeding 



368 SKIN DISEASES. 

at the slightest touch; yellow skin and complexion; erup- 
tions around the mouth, lips and chin, which are con- 
verted into cancerous ulcers, rapidly spreading; pressure 
and dull aching pain in the stomach after moderate eating; 
cancerous ulcer of the mammae, with stinging burning in 
the edges; pus, copious or scanty, smells like old cheese.. 

Hydrastis. — Recommended for all sorts of cancer, but 
it will only act as a regulator for the faulty nutrition^ 
and thus exerts a favorable influence in soft or encepha 
loid cancer. 

Iodide of Arsenic. — Swollen gland in the left axilla, size 
of a hen's ^%%, hard, and exuding a fluid which forms a 
hard, brown crust. The tumor is painful and sensitive 
to the touch; breast of the same side enlarged, indurated 
and very sore. Yellow, bloody, and irritating leucorrhoea, 
with swelling of the labia. 

lodium. — Uterine hemorrhage after every stool, with 
cutting in the abdomen, and pains in the loins and small of 
the back; great weakness during the menses, particu- 
larly in going upstairs; long-lasting uterine hemorrhage;: 
dwindling and falling away of the mammse; aggravated 
from externa] warmth; complete prostration of strength 
and general emaciation; violent vomiting, renewed by 
eating; pulsations in the pit of the stomach. 

Kali phos. — Cancer, pain, offensive discharge and dis- 
coloration. 

Kali sulph. — Epithelioma. Cancer on the skin near a 
mucous lining, with discharge of thin, yellow, serous^ 
mattery secretions. 

Kreosotum. — Shooting stitches in the vagina, burning 
and swelling of the external and internal labia; profuse 
discharge of dark coagulated blood, or of a pungent 
bloody ichor, preceded by pain in the back; aggravation 
of the pains at night; fainting on rising from the bed; 



CARCINOMA. 369 

she alwa3^s feels chill}^ at the menstrual period; complex- 
ion livid; disposition sad, irritable; cauliflower excres- 
cences; wretched complexion, great debility, sleepless- 
ness. Tightness of the pit of the stomach, cannot bear 
the weight of her clothing; painful hard place on the left 
side of her stomach. 

Lachesis. — Melanosis, colloid, and encephaloid cancer; 
violent burning, gangrenous spots; cancer of the breast, 
with lancinating pains; the pit of the stomach very sensi- 
tive to touch; uterine cancer developing itself at the 
climacteric, or as a consequence of the change of life; the 
pains increase rapidly, until relieved by a profuse dis- 
charge of blood; violent pains, as if a knife were thrust 
through the abdomen, which has to be relieved from all 
pressure. 

Lapis albus. — Cancer as long as it has not opened, 
based on scrofulosis. 

Lycopod. — Swelling of the upper lip, with a large ulcer 
on the Vermillion border of the lower one; vomiting of 
food, bile, coagulated blood, and pus; tension in the hy- 
pochondria as from a loop; great emaciation and internal 
debility. 

Mercurius. — Cancerous ulcers, with a severe shooting 
and lancinating pain, not relieved by either hot or cold 
applications; spreading ulcers, spongy, readily bleeding, 
and extremely painful; unequal elevations and depres- 
sions in the floor of the ulcer; swelling of the w^bole or 
only the tip of the nose, accompanied by pain and inflam- 
mation, followed by cancer; pus thin, ichorous, and 
acrid. 

Mezereum. — Scirrhus ventriculi with burning, corrod- 
ing pains; internal surface of the gastric mucous mem- 
brane feels raw, with sensation as if food remained for a 



370 SKIN DISEASES. 

long time undigested in the stomach, causing pressure 
and blood vomiting; hypochondriasis. 

Murex. — Carcinoma uteri, with great depression of 
mind; pain in uterus as if wounded by a cutting instru- 
ment; lancinating, throbbing pains in uterus; acrid dis- 
charge, causing pudenda and thighs to swell and become 
raw, burning and itching; faintness and an "all-gone" 
feeling in epigastrium ; deep hypochondriasis. 

Natru7n carb. — Induration of neck of womb, os uteri 
out of shape; pressing in hypogastrium towards genital 
organs, as if everything would come out; headache in 
sun and from mental labor; great nervousness and 
anxiety. 

Nitric acid. — Pain and swelling of the submaxillary 
gland, with induration, ultimately becoming scirrhous; 
burning sensation in the stomach; mercurio-syphilitic 
taint; urine very offensive; aggravated after midnight; 
in uterine cancer sympathetic affection of the inguinal 
glands; violent cramp-like pains, as if the abdomen 
would burst, with constant eructations; violent pressing, 
as if everything would come out of the vulva, with pain 
from the back down the thighs. 

Nux vom. — Ulcers with pale red, elevated edges; a 
painful, small, scirrhous tumor on the forehead; vomit- 
ing of sonr-smelling mucus and dark clotted blood. 

Nupha?'. — Several cases of cancer have been reported 
as cured by the use of this drug. Its use is empirical, 
and comes to us from the Indians. 

Phosphorus. — Cutting pains through the abdomen, 
sometimes with vomiting, painful to the touch, and when 
walking; belching up of large quantities of wind after 
dinner; frequent and profuse hemorrhages, pouring out 
freely, and then ceasing for some hours or days. 



RODENT ULCER. 371 

Phytolacca. — Scirrhus, especially mammae; cancer of 
lips and cancerous, ill conditioned ulcers of the face. 

Sepia. — Suspicious tubercle on lip of a cartilaginous 
appearance, sometimes bleeding and having a scirrhous 
appearance, with a broad base; epithelial cancer of lip, 
with burning pain and a pricking as from a splinter of 
wood; complexion yellow and earthy; cancer of rectum; 
indurations, ulcerations, and congestion of the os and 
cervix uteri; cutting pains in abdomen and a pressure on 
uterus downward, as if everything would fall out; sinking 
sensation at pit of stomach. 

Silicea. — Painful dryness of the nose; scirrhous indura- 
tion of the upper lip and face; continuous nausea and 
vomiting, especially when drinking; sensitiveness of the 
pit of the stomach; melancholy; in uterine cancer dis- 
charge of blood between the regular periods, with 
repeated paroxysms of ic}^ coldness over the whole body; 
fetid, brownish, purulent, ichorous leucorrhoea. 

Staph. — Scurfy and burning painful lips with pain in 
the submaxillary glands, with or without swelling. 
Syphilis and mercurialization. 

Thuja. — Sycosis; cauliflower excrescences; medullary 
and fungoid cancers. 

Zincum — Pewter-like hue of the face; scirrhous tumors 
in different parts of the body. 

Rodent Ulcer. 

Rodent ulcer has been called cancerous ulcer of the 
face, cancroid ulcer, ulcus exedens, noli 7ne tangere. A. 
patient has a small tubercle upon the face, covered by a 
smooth skin; he may call it a wart, and it may remain on 
the face unaltered for years, and then, when the patient 
gets old, it may begin to ulcerate. The ulcer spreads 



372 SKIN DISEASES. 

slowly, but constantly, and if it be left alone it may 
destroy the whole of the cheek, the bones of the face, and 
ultimately the patient's life; but it may take some years 
to run this course. 

The disease is entirely local. It does not affect the 
lymphatic glands, nor do similar tumors appear on other 
parts of the body. The disease usually attacks some 
part near the eyelids; it is of slow progress; there is 
little pain. The disease has been described as commenc- 
ing as a *' pimple," " a blind boil," "a small hard pale 
tubercle," etc.; which tends to scab after a small central 
crack makes its appearance. There is, in fact, a small 
pimple followed by a minute ulcer. The disease extends 
gradually in all directions, but very slowly. When an 
ulcer forms, the edge is indurated and raised, but not un- 
dermined and everted; and there is no infiltration of the 
surrounding healthy structures. The surface of the 
ulcer is dry, clean, glossy, and does not give exit to any 
foul secretion; it is irregular in form, more or less oval, 
however. 

The disease differs clinically from the ordinary progress 
of cancer by its greater slowness, the little pain and 
hemorrhage, the absence both of any attempt at the for- 
mation of a fungoid growth, and of fetor. The glands, 
moreover, are never affected. The advances of the de- 
posit and ulceration are unequal, hence the eaten-out or 
rodent appearance. The ulceration advances in extent, 
and in depth. The growth is always in one mass, not in 
distinct centers. 

Rodent ulcer then occurs on the face, has an indurated 
edge, a tendency to spread without respect to kind of 
tissue, is of slow progress, painless, is not related to 
any cachexia, never causes enlargement of glands, and 
microscopically presents characters that betoken it as the 



RODENT ULCER. 3 73 

least expressed form of the cancerous cachexia. It is 
most common between fifty and sixty, and it does not 
occur before thirty; generally it has its seat about the 
eyelids, and occurs in either sex equally, and it never at- 
tacks the lower lip. 

The treatment is simple and satisfactory. Experience 
teaches that extirpation by the knife is the most success- 
ful mode of treatment. 

One case is reported where the application of lactic 
acid resulted in the speedy cure of a rodent ulcer. 

The following homoeopathic remedies may be com- 
pared: Arsenicum, Belladon7ia, Cicuta, Hepar, Hydro- 
cotyle, Hydrastis, Mercurius, Nitric acid, Silicea, Sta- 
phisagria, Sulphur, Uranium. 



CHAPTER XV. 

CUTANEOUS HEMORRHAGES. 
General Remarks. 

Blood may be effused into the skin under a variety of 
circumstances. The occurrence may take place as an 
idiopathic condition spontaneously ; or secondarily in con- 
nection with other diseases of the skin. The blood-ves- 
sels may be ruptured, and so permit the escape of blood, 
or the blood globules may escape bodily through the 
actual vessel walls. The usual cause of rupture is trau- 
matic injury. The hemorrhagic spots receive different 
names according to their size and shape. When they are 
small, in the form of red points, they are Q^Vi^d. petechics ; 
when larger, and more or less linear, vibices; when large 
in the form of bruises, ecchymosis; and when the blood 
collects in the form of a distinct tumor, hcBmatomata. 

The seco7idary forms of cutaneous hemorrhage occur in 
connection with typhus, measles, scarlatina, and variola, 
the early eruptions of which may severally be more or 
less hemorrhagic, the hypersemia being accompanied by 
actual hemorrhage into the skin. The eruption of sev- 
eral of the ordinary inflammatory diseases of the skin 
also are sometimes complicated by a certain amount of 
effusion of blood. Other conditions under which cuta- 
neous hemorrhages arise are altered states of the blood 
current, such as impurifications by bile products, stasis of 
the capillaries produced in connection with kidney and 
heart disease, etc. 



PURPURA. 375 

It is only to hemorrhage occurring as a primary and 
independent disease that the term purpura is applied, and 
this we will now describe. 

Purpura. 

Purpura is an affection of the skin characterized by the 
sudden appearance of reddish macules of varying size 
and on various parts of the body. In a short time they be- 
come purplish, the color not being removable by pressure. 
After they have existed a few days they undergo changes 
in color similar to those which follow a bruise. 

The eruption ma}^ appear in either sex, at any age, 
and in almost any condition of general health; in those 
who are greatly enfeebled as w^ell as in those in an ap- 
parentl}^ robust condition. 

The eruption may cover the greater part of the surface, 
but more frequently is confined to the lower extremities. 

A single purpuric outbreak may be the beginning 
and end of the trouble, or, as frequently happens, fresh 
crops may appear at regular or irregular intervals for a 
considerable period. The affection has been noticed in 
connection wnth suppressed menstruation, apparently 
taking the place of the natural flow. The foregoing 
features characterize purpura simplex, which, as a rule, 
is not a serious affection. 

Sometimes, however, the hemorrhages are not confined 
to the cutaneous tissues, but may take place internally as 
well, and serious loss of blood may result from the 
rupture of superficial capillaries in the various mucous 
membranes, and especially those of the gastro-intestinal 
tract. This form is termed purpura hemorrhagica. 

The etiology of purpura is absolutely unknown. It 
has no connection, however, with the congenital anomaly 



376 SKIN DISEASES. 

known as hemophilia, nor with the acquired condition 
known as scorbutus, or scurvy. 

Diagnosis. — The name should be confined to the sim- 
ple affection we have described, and should not be used 
in connection with any other distinct disease that hap- 
pens to be complicated with minute hemorrhagic effu- 
sions. 

Scurvy should never be mistaken for purpura, or vice 
versa. In the former disease the limbs are swollen and 
tense, and the hemorrhages form diffuse patches rather 
than macules. The gums also are swollen, and ready to 
bleed at the slightest provocation. Purpuric blotches are 
likewise met with in speliosis rheumatica; but the pro- 
nounced arthritic symptoms serve as a mark of distinction. 

Petrone found single, small, ovoid micrococci in the 
blood of a young man who was suffering from purpura 
hemorrhagica rheumatica febriHs. Some of his blood 
was subcutaneously injected into a rabbit. After two 
days numerous hemorrhagic spots appeared in the skin of 
one ear. By this experiment Petrone thinks he has 
demonstrated the infectious nature of the disease. 

Treatment. — Piffard says that one drug stands pre- 
eminent and alone as an efficient agent in the treatment 
of purpura, and this is ergot. He advises the use hypo- 
dermically of ergotine, or drachm doses of the fluid ex- 
tract given internally two or three times a day. He also 
advises against the use of iron, quinine, and similar drugs 
of the tonic class. 

The diet should consist of the most nutritious articles. 
Malt preparations are useful foods. Outdoor exercise is 
very beneficial. Locally, hamamelis is one of the best 
remedies, and when there is much hemorrhage, ice treat- 
ment may be resorted to. 



PURPURA. 377 

Simple purpura responds best to Ars. aid., and the 
hemorrhagic form to Sulph. acid. Other remedies may- 
be indicated as follows: 

Arnica. — Yellow, blue and reddish-blue spots; in ly- 
ing-in women. 

Baptisia. — Livid spots all over the body and limbs, of 
the size of a three-cent piece; great languor; desire to lie 
down; tired, bruised, sick feeling all over the body. 

Berberis. — Petechise on the right shoulder or left 
humerus, back of the head and wrist. Bruised pain 
with stiffness and lameness in small of back; renal or 
vesical complications. 

Chloral. — Its continued use internally has caused pur- 
pura hemorrhagica, preceded by a bright red blush, ery- 
thematous in aspect, but permanent under pressure, fol- 
lowed in two days by deep red spots, mixed with mottled 
livid patches. The buccal mucous membrane becomes 
red, raw, ulcerated, and blistered, breath fetid, pulse 120 
and feeble. A desquamation ensued, but with bed-sores 
in some places. In other cases it caused petechise, vibices, 
and ecchymoses. 

Cocoa. — Dark spots like ecchymoses under the skin, 
about the size of a pin's head, on the fingers. 

Erigeron. — When apparently well-indicated remedies 
fail. 

Ha7namelis. — Hemorrhagic purpura; profuse epistaxis; 
passive, venous hemorrhages; great lassitude and weari- 
ness; in old people. 

Lachesis. — Simple purpura; blackish-blue spots; great 
physical and mental exhaustion; climacteric troubles. 

Mercurius. — Bluish-red spots, darker on the margin 
and lighter in the centre. Other symptoms of Merc. 
present. 



25 



378 SKIN DISEASES. 

Phosphorus. — Petechial spots on the skin; bluish-red 
spots on the legs; purple-like exanthem over the whole 
body. 

Rhus tox. — Simple purpura; dark brown spots on in- 
side of ankles; rheumatism of joints worse during rest; 
swollen ankles after sitting too long. 

Terebinth. — Hemorrhagic purpura; intestinal hemor- 
rhages; hematuria. 

Verat. vir. — Simple purpura; galvanic- like shocks in 
the limbs; rapid pulse; slow respiration; in plethoric in- 
dividuals. 



CHAPTER XVI. 

Pruritus. 

Pruritus is characterized by the occurrence of itching; 
in fact, pruritus is itching. It may co-exist with, or be 
entirely unaccornpanied by, organic change in the skin; 
and a knowledge of the conditions under which it occurs 
is essential. 

Pruritus occurs in the course of most inflammations of 
the skin; in connection with rheumatic manifestations; 
the circulation of morbid elements, as bile, urinary ex- 
creta; elevations of temperature, senile decay of the skin, 
gastro-intestinal disturbance, nervous diseases, Bright's 
disease, genito-urinary and uterine derangements, seden- 
tary habits, and stimulating diet; it is also occasioned by 
local causes; about the rectum by ascarides and piles, and 
over the body in various parts by parasites (animal or 
vegetable). When pruritus is spoken of in the abstract, 
itching, as constituting the primar}^ and sole disease pres- 
ent, is signified, and the nervous character of the itching 
is frequently shown by its sudden appearance, its almost 
as sudden disappearance, and often its marked tendency 
to periodicity. 

Pruritus may be general or local, and it is very gener- 
ally followed by secondary changes in the skin. When 
general it is due to the causes of more general operation, 
mentioned above. 

When pruritus occurs, of course in most cases the 
-patient scratches more or less violently for the relief of 



380 SKIN DISEASES. 

the itching, and this induces certain special diseased con- 
ditions. In fact, the phenomena of a scratched skin are 
produced, or what is termed a '' pruriginous eruption.''' 

In certain cases pruritus exists in the first place as ap- 
parently the sole disease, and in which scratching is 
practiced, and eruptions follow. These conditions we 
will now discuss. 

Pruritus Senilis. — In old people whose skin begins 
to exhibit atrophous changes the sensibility of the skin 
is much disordered and more or less associated pruritus 
occurs. The practitioner is consulted for this pruritus, 
and at first there is nothing else to be observed in the 
skin but laxity and thinness of the integuments, with 
perhaps plugging up of a certain number of the follicles 
by the exuviae shed from the sebaceous glands. The 
pruritus is the evil from which the patient desires to be 
rid. It is increased by heat, cold, the warmth of the bed, 
by digestion, and other things. These cases may be re- 
lieved by the use of alkaline baths, free oiling of the sur- 
face, or some local anodyne application. Besnier advises 
in these cases that the patient bathe in a solution contain- 
ing to each litre a solution of carbolic acid lo.oo to 500 
grammes of acet. aromat. This should be followed by 
dusting the affected parts with amylum, 90; bismuth 
salicyl., 20.0. 

After awhile the scratching practiced to relieve the ir- 
ritation induces the development of distinct eruptive 
phenomena. A certain amount of hypersemia occurs, and 
this is followed by the formation of lymph papules, which, 
being scratched, become pruriginous — that is to say, the 
apices are torn, a little blood oozes out and dries on these 
apices as a dark speck. These changes are followed by 
more or less infiltration of certain parts, by the inter- 
mingling of excoriations made by the nails with the pru- 



PRURITUS. 381 

riginous rash, and in some instances by ecthymatous pus- 
tules or urticaria. The pruritus is often intense, and 
takes the form of a stinging, creeping, or burning sensa- 
tion. The pruritus is the primar}^ as it is occasionally 
the sole condition. The disease may be, of course, more 
or less general, or more marked in one place than an- 
other. 

The cure of pruritus senilis is, too, effected by emollient 
and vapour baths, and anodjmes, locall}^ applied. The 
following formulae are often of benefit: 

1^. Sodii Hyposulphit, dr. j. 

Acid Carbol., dr. ss. 

Glycerini, oz. j. 

Lislerine, oz. iij. 
M. Sig. : Use as a lotion. 



Or, 



Or, 



Or, 



Or, 



1^. Ammon. sulpho-ichthyolat, 5jj- 

Aquae rosge, 

Glycerini, aa 3ss. 
M. Sig.: Use as a lotion. 



fl. Opium, gr. viij. 

Creasote, gtt. x. 

I^ard, 5Jj. 
M. Sig.: Use locally. 



9^. Tincture of myrrh, gtt. xxx. 

Oxide of zinc, gr. xx. 

Cold cream, 5J. 
M. Sig.: Use locally. 



9^. Carbonate of soda, 3ss. 

Conium juice, ^j. 

Elder flower water, §j. 
M. Sig. : Use locally. 



382 SKIN DISEASES. 

The above formulae, and many others, may be used in 
any of the forms of pruritus. Under the varieties men- 
tioned below, some other means of affording relief will be 
noticed. 

Pruritus Ani. — Itching about the anus arises from a 
variety of causes. It is a common consequence of piles, 
as carides, tinea circinata, the friction of the parts in 
stout people (intertrigo), gout, and uterine disorder. It 
occurs from the latter by reflex action. It is often very 
troublesome. The result of scratching is to give rise to 
the development of papulae, and, it maj^ be, considerable 
inflammatory thickening. 

The practitioner must of course discover any local 
cause for the disease, and take care to negative its opera- 
tion. The same local applications recommended for the 
preceding will be useful. In addition I would advise the 
following: 

9^. Oil of bitter almonds, ^ij. 

Cyanide of potassium, gr. x. 

Galen's cerate, ^ij. 
M. Sig. : Apply locally. This must be used with great 

caution. 

Pruritus PrcEputii. — Is merely itching about the glans, 
connected with an abnormal secretion from the follicles of 
that part. The remedy is free washing with soap and 
water and the application of an oxide of zinc powder or 
lotion, as follows: 

^. Oxide of zinc, 5ij- 

Glycerine, 5ij- 

Lead-water, 3iss. 

lyime-water, §vj to viij. 
M. Sig.: Apply locally. 

Pruritus Piideyidi, or itching about the genital parts, 
is common in women, and arises from a variety of causes 



PRURITUS. 383 

— eczema, intertrigo, the presence of vegetable fungi, 
ovarian and uterine irritation, hemorrhoids, and varicosity 
of veins of the genital parts. In those cases in which 
there appears no structural change relief is to be obtained 
by the locally applied anodynes, care being taken to treat 
any uterine or ovarian disease appropriately. 

For the relief of the itching the following means may 
be .used: The cure of the complaint in any of its above 
forms can only be accomplished by the administration of 
the properly indicated homoeopathic remedy, hints of 
which will be found at the close of this article. In many 
cases, relief will be demanded for the excessive itching, 
and in such cases it is admissible to make use of one or 
more of the following: 

1^. Hyposulphite of soda, 5j. 

Glycerine, ^j. 

Water, giij. 
M. Sig. : Use locally. 

Peppermint water is one of our best local applications 
in the above-mentioned forms of pruritus. Patients can 
easily make their own lotion, as required for use, by 
putting a teaspoonful of borax into a pint bottle of hot 
water, and adding to it five drops of oleum menthae 
peperitse, and shaking well; the parts affected to be freely 
bathed with a soft sponge. 

If cracks, or sores, or eczema, or rawness be present 
this lotion will be too severe. Olive oil, with five grains 
of iodoform to the ounce, is better. 

A sitz bath of cold water is often beneficial. 

Galvanism, as a remed}^ in pruritus vulvae et ani, is a 
valuable adjuvant. A current from six elements with 
the anode applied to the vulva and the cathode to the af- 
fected portions of the integument. The sittings should 
last about ten minutes. 



384 SKIN DISEASES. 

Therapeutic Hints: 
Itching as if from ants: I^ach., Phos., Puis., Secale. 
Bitings: Berb., Bry., Chin., Colch., I^ach., Led., 

Magn. acet., Merc, Nux vom., Oleand., Puis. 
Burning: Agar., Arg. n., Ars., Bry., Calad., Caps.» 

Cic, Kupliorb., Hep,, Ign., Merc, Nux vom., Ran., 

Rhus, Sabad., Spig., Staph., Sulph., Verat., VioL 

od. 
As if from congelation: Agar. 
Corrosive itching: Rhus ven. 
Crawling: Arg. n., Ars., Dulc, Magn. c, Sil., Spig., 

Staph. 
Creeping: Sil. 
Dull: Hepar. 

As if electric sparks: Phell. 
As if from fleas: Arg. n., Lyco. , Magn. acet., Merc, 

Mezer., Oleand., Puis., Sil., Spong., Staph., 

Tabac, Teucr., Thuja, Zinc 
Gnawing: Agn., Ars., Cocc, Dig., Euphorb., Magn. 

aust., Oleand., Plat., Puis., Rhod., Ruta. 
Intolerable: Merc, Sil. 
Itch-like: Amb., Merc, Verat. 
Jerking: Staph. 
Itching as of lice: Arg. n., Canth., Magn. m., Plat., 

Zinc 
As from mosquito-bites: Rhus ven. 
As of nettles: Colch., Lupul. 
Painful: Alum., Ammon., Baryt., Cham., Cocc, 

Lupul., Nitr. 
Pinching: Mosch. 
Pleasant: Merc. 
Prickling: Cin., Plat., Zinc. 
Stinging: Agn., Arg., Arn., Asaf., Bry., Con., Cycl., 

Dros., Graph., Ign., Led., Magn. acet., Merc, 



PRURITUS. 385 

Oleand., Puis.. Ran. sc, Rhus, Ruta, Sabina, 

Spig., Spoiig., Squill., Stan., Staph., Thuja, Ver., 

Viol. tr. 
Tearing: Bell., Bry. 
Tickling: Agar., Calc. c, Euphorb., Merc, Plat., 

Puis., Ruta. 
Titillating: Bell., Chel., Chin., Plat., Puis., Rhod., 

Sabad., Squilla. 
Violent: Agar., Dros., Ipec, Lach. 
Voluptuous: Anac, Merc, Sulph. 
Wandering: Cham., Graph., Kali c, Magn. m., 

Mez., Rhus v.. Staph., Zinc 
Of wounds: Chin., Tart. emet. 

Location. 
Anus: Alum., Ambra, Amm. c, Anac, Calc. c> 

Carbo veg., Caust., Kali c, Lyco., Nux vom., 

Phos., Sabad., Sep., Sil., Spig., Sulph. 

nates, between the: Alum,, Con., Seneg. 

perinaeum: Agn., Alum., Ars., Carbo veg., Ign., 
Mur. ac, Nux vom., Plumb., Tarax. 
Sexual parts: Ambra, Amm. c, Berb., Calc c, 

Cann., Canth., Carbo veg., Caust., Cocc, Coff., 

Raph., Con., Hep., Ign., Kali c, Kreas., lyyco., 

Magn. acet., Magn. m., Merc, Natr. m., Nitr. 

ac, Nux vom., Petr. , Puis., Rhus, Sep., Sil., 

Sulph., Thuja. 

fraenulum: Cann., Caust., Hep., Merc. 

glans: Merc, Natr. c, Natr. m., Nitr. ac, Nux 
vom., Sep., Thuja. 

testicles: Merc. 

scrotum: Berb., Carbo veg., Caust., Cocc, Graph., 
Lyco., Nitr. ac, Nux vom., Petr. 

clitoris: Sulph. 

penis: Nitr. ac. 



386 SKIN DISEASES. 

mons veneris: Kali c. 

labia: Amm. c, Calc. c, Carbo veg., Con., Graph., 

Kalic, Merc, Natr. m., Nitr. ac, Sil., Staph., 

Sulph. 
vagina: Canth., Con., Kreas., Sulph. 
prepuce: Cann., Carbo veg., Lyco., Magn. acet., 

Nitr. ac, Nux vom., Puis. 



CHAPTER XVII. 

Chromatogenous Diseases, or Alteration In the 
Pigmentation of the Skin. 

Pigmentary discolorations may be divided into three 
main groups — (i) primary and idiopathic, (2) secondary 
or symptomatic, and (3) congenital. 

The primary or idiopathic pigmentations result from the 
application of irritants, which set up hyperaemia in some 
cases and in others not — as after the action of heat — or 
friction, or irritants, such as mustard plasters, or the 
pressure on a part, as by dresses, mechanical restraints, 
the friction of straps, and the following of certain handi- 
crafts by which certain parts of the body are exposed to 
the sun or specially rubbed, as in masons. Scratching 
also will be followed in some cases by discoloration — this 
is seen in phtheiriasis particularly. 

Secondary or symptomatic staiiiings are those which 
follow in the wake of other diseases, or are due to dis- 
turbance of organs at a distance from the seat of discolor- 
ation that do not, in other words, constitute the essential 
disease, but are secondary to, or form only a part of, the 
essential diseases present in any given case. There are 
three groups of secondary pigmentations: i. Those which 
follow in the wake of and occur in the same seat as cer- 
tain skin eruptions; 2. Pigmentations occurring in con- 
nection with certain cachexias, the latter being associated 
with definite organic diseases of important internal or- 
gans; 3. Physiological pigmentations connected with 
uterine functional changes. 



388 SKIN DISEASES. 

As regards congenital pigmentations^ I need only say 
these are seen in moles and pigmentary nsevi. 

Those cases in which the pigmentation of the skin is at 
fault as the sole existing disease may be divided into two 
classes — those in which the pigment is deficient in 
quantity (Leucoderma, or Vitiligo), and those in which 
it is in excess (Melanoderma). These may be congenital 
or acquired, general or local. The seat of change is the 
rete mucosum. 

Vitiligo. 

Vitiligo, or leucoderma, is an affection characterized by 
circumscribed patches of skin, from which the pigment 
has disappeared to a greater or less extent. At the be- 
ginning the patches will be quite limited in extent, and 
affect by preference the face, neck, hands, and genitals. 
As a rule, however, triey increase for a certain length of 
time, and neighboring patches coalesce. The borders 
of the spots are usually somewhat hyperpigmented, as if 
the pigment which had been removed from the centre had 
been simply deposited at the edges. This feature, how- 
ever, is not always met with. 

The course of vitiligo varies. With some individuals 
it reaches a certain degree of development, and then re- 
mains stationary for years; in others, it progresses in- 
definitely, and this so particularly when it affects the 
negro. 

In perhaps the majority of cases there is a return of 
the natural pigment after the lapse of a few years, while 
in others the affection appears, lasts a few months and 
disappears, only to be followed by one or several re- 
currences. It may be absent during the hot months, and 
return during the cold ones. 

The causes of vitiligo are unknown. It occurs in both 







Vitiligo, 



MELANODERMA. 389 

sexes with apparently the same frequenc}^ and usually 
without being preceded by any acute disease, or general 
failure of health. In fact, the majority of patients will 
complain of nothing except the uusightliness of the af- 
fection, which may pursue its course uncomplicated by 
trouble that can be attributed to it. There is no reason 
for believing that it ever shortens life. When we con- 
sider the permanency and progressive nature of some 
cases, we are utterly at a loss to account for this curious 
affection. 

Treatment. — The old school acknowledge their in- 
capacity to do anything in this affection. Our school is 
but little better off. 

Locally, the pigmentation around the patch may be 
lessened by the use of strong acetic acid. Galvanism 
ma}^ prove serviceable. Internall}* the Sulphide of Arseni- 
cum will be oftenest used with benefit. Natrum c., Nitr. 
ac., Su7?tbul din6. the Phosphide of Zi?ic may be studied. 

Melanoderma. 

This term of course means excess of pigment resulting 
in dark discoloration s, but the altered tint of skin may be 
blue, yellowish, or black; hence the terms cyanoderma, 
xanthoderma, and melasma. 

Melasma^ or that condition in which the discoloration 
of skin is black in color, is general or partial. The 
latter is generally called melasma. It may be a physi- 
ological condition, as seen in the staining around the 
nipple andthelinea alba in pregnancy; this condition may 
be excessive. The varieties of melasma are lentigo and 
ephelis. 

Lentigo is known as freckles. The seat of the pig- 
ment deposit is the rete mucosum; it is often congenital, 
^ and of varying extent and distribution; generally, how- 



390 SKIN DISEASES. 

ever, it consists of round yellowish spots, the size of 
split peas and less, not only on the parts exposed to the 
light, but also those covered by the dress. Lentigo oc- 
curs in those with fair skins, and particularly red-haired 
folk. There is no desquamation, no itching, and no 
heat of any kind in connection with freckles, which 
often disappear after puberty. Freckles do not depend 
upon seasonal change. 

Lentigo may sometimes be made to disappear by an 
application of citric acid night and morning. One 
writer reports the application of emulsion of almonds, 
night and morning, to be the most satisfactory treatment, 
and advises its continuance until a slight amount of des- 
quamation takes place. Another writer recommends the 
application of oleate of copper for the removal of 
freckles. Care should be exercised that a pure sample 
of the drug is obtained. 

^. Cupric. Oleat., ^j. 

Petrolei, ^xvj. 
M. Sig. : Appl> twice a day. 

The internal remedies are: 

Ferrum mag. — Spots resembling summer freckles on 
back of hands and fingers. 

Kali carb. — Freckles on the face. 

Lycopod. — Freckles on the left side of the face and 
across the nose. 

Nitric acid. — Freckles on the chest; dark freckles. 

Petroleum. — Freckles on the arms. 

Phosphorus. — Freckles on the lower limbs. 

Sepia. — Freckles on the cheeks. 

Sulphur. — Freckles on the nose. 



EPHELIS, OR SUNBURN. 391 



Ephelis, or Sunburn. 

In this particular variet}^ of discoloration the pigment 
deposit is excited b}^ the sun's raj^s. Sunburn consists 
of little dots the size of pins' heads, which appear upon 
the parts of the body exposed to the influence of the sun, 
and are seen mostly in lymphatic subjects with delicate 
skins. Temporary benefit accrues from the use of local 
applications strong enough to cause exfoliation of the 
corneal cells. A one per cent, solution of mercuric 
bichloride and a ten per cent, solution of calcium chlo- 
ride are the lotions most commonly used. 

Ver. alb. , Robinia and Kali carb. are useful internal 
remedies. Bufo is indicated when the face tans quickly. 

Melasmic discoloration likewise occurs as the result of 
the action of local irritants — excessive scratching, strong 
lights, blisters 

Pigmentary Ncsvi. — These consist of collections of pig- 
ment in the rete and corium, and a certain amount of 
hypertrophy of the papilla at times. They may be fur- 
nished with hairs. Moles are of this nature. 

Xanthoderma. — In this disease the pigmentary dis- 
coloration is yellowish. It is characteristic of certain 
races, and is due to some special condition of the color- 
ing matter of the skin, molecular or chemical. 

Cyanoderma, or blue discoloration, is different from 
colored sweat. It is a curiosity, if not, at least in the 
greater number of instances, a hoax. 



CHAPTER XVIII. 
PARASITIC DISEASES. 

The parasites are of two kinds, animal and vegetable. 

The principal animal parasites are the Acarus scabiei, 
or itch mite; the Pedicuhis, or louse; the Cimex lectu- 
lariuSy or bedbug; the Ptilex irritans, or flea; and the 
Pulex penetrans, or chigoe. 

The bite of the Cimex lectularius causes a hypersemic 
papule with a small red spot in the centre. That of the 
flea produces a little circular erythematous spot, which 
exhibits a dark speck in the centre, that marks the 
wound made by the insect. The chigoe attacks the feet 
and hands, entering the skin beneath the nails or betwixt 
the toes, or upon some portion of the extremities, either 
by a channel made for itself, or by the ducts of the skin; 
its tracks can sometimes be traced as an elongated brown 
spot. 

The application of a lotion of glycerine and water, of 
each 5jj, and tincture of calendula 5j will be found very 
useful in allaying the irritation in the case of the first two. 
The treatment of chigoe disease consists in dilating the 
original channel of entrance, and carefully removing the 
chigoe bodily; after which apply an ointment composed of 
lard and salt. 

Certain caterpillars, if they get upon the skin, may ex- 
cite urticaria also. 

Children of lymphatic temperament who are not kept 
clean, are poorly nourished, or insufficiently clothed, and 



PHTHEIRIASIS. 393 

live in rooms badly ventilated, are particularly liable to 
vegetable parasitic diseases; and unless measures are 
adopted to remove the exciting causes and predisposing 
conditions treatment is unsatisfactory and relapses are 
frequent. The patients should be isolated whenever 
practicable. 

The varieties are: Tinea favosa, or favus; tinea ton- 
surans; tinea circinata; tinea versicolor; and onychia 
parasitica, 

Phtheiriasis. 

Phtheiriasis is the name applied to the affections pro- 
duced by the invasion of the there well known varieties 
of pediculus — namely, the head-louse, body-louse, and 
pubic or crab louse. 

The nature and appearance of these insects are so well 
known that we need not describe them. The first of 
these infest the scalp; the second confines itself to the 
non-hairy portions of the surface; and the third prefer 
the pubic region, but may be met with wherever the hairs 
are short, but avoiding the scalp. 

Phtheiriasis Capitis. 

This affection occurs most frequently in children, more 
rarely in women, and almost never in men. The insect 
{pediculus capitis) finds its most congenial abiding-place 
in the hair of children, where it lays its eggs, and at- 
taches them by a kind of cement to the shafts of the 
hair. The eggs take but a few days to hatch, and in a 
short time the parts may become pretty thickly settled. 
They derive their nourishment from the skin, and by 
their presence produce considerable itching and lead to a 
corresponding amount of scratching. In children predis- 
26 



394 SKIN DISEASES. 

posed to eczema they not infrequently lead to the devel- 
opment of this affection. 

The diagnosis is, of course, readily made, as inspec- 
tion of the scalp will quickly reveal the presence of the 
insects and their ova, if at all abundant. In doubtful 
cases the fine- tooth comb will soon settle the question. 

The treatment, of course, involves the removal of the 
insects and their ova, usually called " nits." In children, 
clipping the hair as close as possible, or perhaps shaving 
it, is, of course, the quickest way of relieving the patient 
of these pests. When this is not practicable, the scalp 
should be thoroughly washed with tincture of staphisa- 
gria, or with ordinary kerosene oil. A few applications 
will kill the living insects, but do not appear to destroy 
the vitality of the ova. These should be removed as far 
as possible with the fine-tooth comb. Many, however, 
will still remain, and the best way to get rid of them will 
be to go over the scalp carefully and clip the shafts of all 
the hairs to which they are attached. The head should 
be washed for a week or ten days, for fear some of the 
eggs may have escaped detection. It is almost needless 
to say that soap and water, freely used, are essential ad- 
juvants to the means just mentioned. 

The following is a very excellent application: 

9? 01. Staphisagrise, ^j. 

01. Ivimonis, dr. j. 

01. Amygdalse, ^iv. 
M. Sig. : Apply to the aflfected parts daily. 

Phtheiriasis Corporis. 

This affection is very rarely met with in young persons, 
and is found most frequently in middle and advanced 
life, and especially in the feeble and ill-fed, and among 



PHTHEIRIASIS PUBIS. 395 

the frequenters of prisons and cheap lodgings. Though 
sometimes met with in women, nine- tenths of the cases 
are among men. 

Th.Q pediadus coj'pojHs diOQS not lodge upon the body, 
but infests and breeds among the folds of the under-gar- 
ments, from which hiding places it sallies forth to seek its 
nourishment from the skin. This it pierces with the 
sucker, and continues to feed until gorged with blood. 
These insects excite at times a liveh^ and most annojnng 
itching, and lead to vigorous scratching. In cases that 
have lasted for any length of time, the skin gradually 
<3arkens, even to the color of a mulatto. 

Diagnosis. — After a little experience a case of phthei- 
riasis will, in most cases, be recognized at a glance, and 
should alwaj^s be proved by a careful search for the in- 
sects. Strip the patient, if possible, and then examine 
not his skin, but his shirt, and, as a rule, you will find 
the pediculi, if present, without dijB&culty. 

Treatment. — Soap, water, and clean clothes are all 
that are necessary. The old clothes should be destroyed, 
or thoroughly disinfected by boiling or baking. 

Phtheiriasis Pubis. 

ThQ pediculus pubis affects a preference for the pubic 
region of both sexes, but is not confined to this locality; 
but in women may also be met with in the axillary 
region and in the eyebrows, and in men among the chest 
hairs and in the baard and whiskers. It rarely gives rise 
to as much irritation as the other varieties of pediculus, 
and its presence is often discovered accidentally. The 
insect attaches its eggs to the hairs like the pediculus 
capitis, and adheres to them itself or to the skin in the 
most tenacious manner by the aid of its crab-like claws. 



396 SKIN DISEASES. 

The diagnosis is to be made by the discovery of the 
insect, but, having been found in its favorite seat, thor- 
ough examination of all other parts of the body liable to 
be infested should not be omitted. 

The treatment of this affection involves the employ- 
ment of some anti-parasitic application, and the one most 
in vogue is the common ** blue ointment." When, hov^^-^ 
ever, the patient will consent to it, shaving of the affected • 
parts is to be preferred. The affection is most frequently 
contracted during sexual intercourse, but may be de- 
rived from wearing infected clothing, or sleeping in an 
infected bed. The patient's under-clothes and bed-clothes 
should be boiled or baked, in order to destroy the insects 
and their eggs. 

Psorospermosis. 

Psorospermosis may be defined as a condition of the 
skin of varied lesion, but characterized by the presence 
of " psorosperms." The psorosperm is a living animal 
parasite, which infests the human skin as well as the 
bodies of some of the lower animals, and consists of a 
roundish or oval cell, containing one or more neuclei; 
the nucleus occupying but a small portion of the cell, the 
plasmic portion of which is extremely transparent and 
structureless. 

Much doubt exists among dermatologists as to the 
nature of this affection; and but little is known positively 
concerning it. 

Scabies. 

Scabies is a contagious affection of the skin character- . 
ized by the development of vesicles, pustules, and other t 
lesions on the skin, and caused by the presence of an 
animal parasite, known as the Acarus scabiei. 








Scabies. 



SCABIES. 397 

The affection usually commences by the appearance of 
small, non-umbilicated vesicles on the hands and between 
the fingers, accompanied with severe itching. The itch- 
ing leads to scratching, and as a consequence transfer of 
the affection to other parts of the body with which the 
Tiands are brought in contact. Very earl 3^ in the disease, 
then, we will find it appearing on the penis, on the breasts 
in women, and on the feet in children. From these parts 
it may spread over the greater part of the surface, more 
profoundly on the anterior than posterior parts and avoid- 
ing the face and scalp. 

The vesicles above mentioned may be termed the 
primary lesions of the disease, but are usually followed 
in a few days by others secondary to the irritation pro- 
duced by the insect, and to the effects of the finger 
nails. These new lesions may be papular or pus.tular in 
character, and may even assume distinctly eczematous 
characters, or develop into a true eczema in those predis- 
posed to this affection. On the penis the lesions are 
usually papular. None of these features are absolutely 
pathognomonic. There is, however, a lesion which is met 
with in no other disease, and which when found renders 
the diagnosis absolute. This is a fine, grayish line fre- 
quently terminating in a vesicle, and found between the 
fingers more frequently than elsewhere. It is called the 
4icarian burrow. When an impregnated female acarus 
finds lodgment on the skin, she immediately seeks a 
place in which to deposit her eggs. This she accom- 
plishes by boring beneath the epidermis and laying an 
€gg» and then advancing in a straight or slightly curved 
line for several days until ovulation is complete. She 
then dies, and her decomposing remains give rise to a 
vesicle or pustule. When the eggs hatch, the young find 
their way to the surface, and as soon as they assume the 



398 SKIN DISEASES. 

adult form copulate, and the impregnated females com- 
mence to burrow as did their mother before them, A 
sharp needle-point, if guided by a sharper eye, will 
sometimes extract the acarus from her nest. The male 
acarus never burrows, and is very rarely detected. 

Etiology. — Scabies is one of the few diseases of which 
we can say that we absolutely know the cause; and yet 
there is no chapter in medical history more interesting 
than that which concerns the etiology of this affection. 

The acarus is exceedingly minute, and when first 
hatched has but six legs. It soon assumes its adult form,, 
however, with eight legs; and the sexes are easil}^ distin- 
guished by the fact that in the female the four posterior 
legs are furnished with projecting hairs, while in the 
male two of these legs terminate in suckers instead of 
hairs. 

Diagnosis. — The diagnosis of scabies should not in 
most cases be difiicult. The early vesicles on the hands 
are either to be found, or the patient may tell you that 
the affection commenced with small ''watery pimples." 
Next, examine the penis, and you will rarely miss find- 
ing papules on the glans or papules or vesicles on the 
cutaneous surface. Rather good-sized isolated pustules 
about the wrists are commonly present, and in women 
you usually find an eczematous eruption around the 
nipple. If on inquiry you find that one or the other of 
the patient's associates is suffering from a similar trouble, 
and that he has slept with him or worn his clothes, you 
may be fully confident of the diagnosis. 

The mere presence or the intensity of the itching can 
not be relied on to establish the nature of the disease, as 
in several other affections intense pruritus is a marked 
feature; and this is notably the case in phtheiriasis, pro- 
duced by the pediculus corporis, or body louse. The 



J. 



SCABIES. 399 

papules or other lesions on the penis should not be mis- 
taken for lesions of venereal origin. 

To briefly sum up, then, the diagnostic points are: 

1. A history of contagion. 

2. The development of minute papulo- vesicles or ves- 
icles, spreading on contiguous portions of the skin or on 
parts habitually handled by the patient (never in patches 
but in rather a scattered manner). 

3. Itching, worse at night and becoming progressively 
worse as larger areas become invaded by the itch-mite. 

4. Sites of predilection shown by the disease. They 
are the webs of the fingers, the front of the wrists, the 
anterior edges of the axillae, the mamma, the penis, the 
abdomen and groins, the toes and feet. Flexor surfaces 
are more involved than extensor. 

5. That the face remains free from the disease, except 
in the case of infants at the breast. 

6. That it has taken about three weeks for the disease 
to involve the whole surface. 

7. That old cases show all the lesions that can possibly 
be produced by disease of the skin, expressed by the 
term multiformity of lesions. 

8. Incidentally — numerous scratch-marks. 

9. The itch-mite and its canaliculi. 

Treatment — However distressing the present symp- 
toms, the patient may be confidently assured of speedy 
relief. This may be most promptly brought about by 
adopting the following somewhat vigorous treatment: 
Put the patient into a warm bath and let him soak for 
fifteen or twenty minutes. Then let him be rubbed thor- 
oughly all over with soft soap, assisted with a flesh- 
brush. Every part of the body from the neck down 
should receive a thorough application of the soft-soap 
and water and brush, in order to break over the burrows 



400 SKIN DISEASES. 

of the insects. The soap is then washed off and the sur- 
face rubbed dry. Then rub the entire surface with alka- 
line sulphur ointment to each ounce of which a 
drachm of iodide of potassium has been added. After 
a thorough inunction the patient should go to bed and 
stay there until the following morning. When morning 
comes a warm bath should be given to remove the oint- 
ment, and the patient should put on new under-clothes. 
The under-clothes and bedding that have been in use 
should be thoroughly disinfected by boiling or baking, in 
order to destroy any wandering acari. This treatment is 
effective but harsh, and for a day or two the patient's 
skin will be far from comfortable, and the eczematous and 
other secondary lesions will be greatly aggravated. 
Emollient treatment, therefore, will in almost every in- 
stance be needed for a few days longer, and the use of 
the oxide of zinc ointment is as good as any. 

One of the following B's is, I think, far preferable, and 
less annoying to the patient: 

^ Beta naphtholi, 

Balsam Peru, da gm. x 

Sapon. kalini viridis, 

Cretse albae pulveris, da gm. xx 

Vasogen. Sulph (3 per cent.) spiss. gm. x L. 

M. f. unguentum. 

Twenty-four hours' covering of the affected parts is 
sufficient in most cases 

Or, 

P^ Sapon. med., 100. 
01. petrae., 
Alcotiol, dd 50. 
Cerae alb., 40. 
M, Sig. : Soap the whole body with this three or four times 
daily and the itch-mite will be destroyed. 



SCABIES. 401 

Another, which has proved very efficacious in destroy- 
ing the acarus scabiei, is: 

^ Naphthol, 15. 

Lard, 100. 

Green soap, 50. 

Prepared chalk, 10. 
M. ft. Unguent. 

For obstinate cases the following is excellent: 
^ Pelroleum, 50 parts. 

White wax, 40 parts. 

Alcohol, 50 parts. 

Soap, 100 parts. 
M. Sig. : Apply locally. 

Remedies indicated: 

Arsen. alb. — Inveterate cases; eruption in the bends of 
the knees; pustular eruption, burning and itching; better 
from external warmth. 

Carbo veg. — Eruption dry and fine, almost over the 
whole body, worst on extremities; itching worse after un- 
dressing; dyspeptic symptoms, belching of wind and 
passing flatus; after abuse of mercurial salves. 

Caiisticum. — After abuse of sulphur or mercury; yel- 
lowish color of face; warts on the face; involuntary urina- 
tion when coughing, sneezing, or walking; sensitive to 
cold air. 

Croton tig. — Itching and painful burning, with redness 
of skin; formation of vesicles and pustules; desiccation, 
desquamation, and falling off of the pustules. 

Hepar. — Fat, pustular, and crusty itch; also after pre- 
vious use of mercury. 

Lobelia. — Pricking itching of the skin all over the 
body. 

Lycopodium. — Humid suppurating eruption, full of 
deep fissures; itching violently, when becoming warm 
through the day. 



402 SKIN DISEASES. 

Mercurius. — Fat itch, especially in the bends of the 
elbows, if some of the vesicles become pustular; itching 
all over, worse at night when warm in bed; sleepless at 
night from the itching; diarrhoea. 

Psorinum. — Inveterate cases, with symptoms of tuber- 
culosis; also, in recent cases, with eruptions in the bend 
of the elbows and around the wrists; repeated outbreak 
of single pustules after the main eruption seems all gone. 

Sepia. — After previous abuse of sulphur; itching worse 
evenings, especially in females. 

Sulphur, — Mai7i remedy; voluptuous tingling, itching 
with burning and soreness after scratching; worse in 
warm bed; disposition to excoriation; glandi&lar swellings. 

Sulph. ac. — When itchiness of skin and single pustules 
appear every spring; after imperfectly cured itch. 



VEGETABLE PARASITIC DISEASES. 

Favus. 

Favus is a parasitic disease of the skin caused by a 
minute vegetable fungus. 

This disease may affect any portion of the body where 
there are hairs; but it pre^fers the scalp, especially the 
scalps of children. The fungus on which the disease de- 
pends is called Ackorioji Schonlemii, and falling on a con- 
genial soil, gains access to the hair follicles, where it 
spreads and multiplies. In a short time it is perceived 
on the surface as a whitish speck, and later forms a very 
light-yellow umbilicated crust, the centre of which is per- 
forated by a hair. A number of contiguous cups may 
coalesce, forming a crusty patch. The fungus, by its 
development and increase, presses on the follicular con- 
tents, and interferes with the nutrition of the hairs, and 



FAYUS. 403 

in time insures their destruction and permanent disap- 
pearance. Favus of the scalp usually makes its first ap- 
pearance in childhood. Spontaneous cure rarel}', if ever, 
occurs; and the affection lasts indefinitely — that is, as 
long as there is a hair follicle left for the achorion to lodge 
in. In this way the affection may be prolonged for 
twenty years or more. The most striking features of a 
long-standing case are the sparseness of the hairs over the 
affected area, the appearance presented being entirely 
different from that of any of the commoner forms of 
alopecia. The peculiar crusts may be present to aid the 
diagnosis, but not infrequently they are entirely absent 
from the surface, -as various ointments, or even plenty 
of soap and water, are sufficient to prevent their develop- 
ment on the surface to an extent to prevent them to be 
visible to the naked eye. 

The progress of the affection is extremely slow, and, 
when not checked by efficient treatment, may last for 
twent}^ years or more. 

Favus on the body — that is, on the trunk or extemities 
— first exhibits its presence by a small erythematous, 
patch like a commencing ringworm; this spreads until it 
has a diameter of an inch or more, when the character- 
istic crusts appear. 

Etiology. — The disease is due to a vegetable parasite, 
and is communicable from one to another. This disease 
is not infrequent in the common domestic mouse, from 
which animal it is sometimes conve3^ed to the household 
cat, who in turn transmits it to the children of the 
family. 

Diagnosis. — In most cases the diagnosis is easy. If 
the affection is in full efflorescence, it can hardly be mis- 
taken for anything else, as there is no other disease that 
presents the characteristic umbilicated, light yellow, and 



404 SKIN DISEASES. 

dry crusts. lu an advanced case the peculiar alopecia, 
marked by the presence of a few, scattered, lusterless 
hairs, distinguishes it from every other form of baldness. 
In doubtful cases the microscope will reveal the parasite, 
which consists of minute spores and mycelium. 

Treatment. — The treatment of favus of the general 
surface is exceedingly simple. All that is necessary is to 
pick off the crusts and make a few applications of tincture 
of iodine, or other efficient parasiticide, to the affected 
patches. 

When, however, the affection is located on the scalp, 
it is very difficult to cure. The primary indication is to 
destroy the parasite. As this fungus flourishes in the 
lowest depths of the hair follicles, ordinary applications 
made to the surface are not sufficient. It is necessary to 
attack the parasite in its stronghold, and this can only be 
done by first extracting the hairs. These should be re- 
moved by properly constructed epilation forceps. After 
epilation a solution of corrosive sublimate, two grains to 
the ounce, should be rubbed in. This should be repeated 
daily until a considerable degree of irritation is produced. 
The artificial irritation should be sufficient to produce ex- 
foliation of the epithelial lining of the follicle. If the 
affected surface is at all extensive, it is hardly practicable 
to epilate and mercurialize the whole of it at a single 
sitting; it should be done in sections. This treatment 
should be continued with as much regularity and thor- 
oughness as circumstances will permit. In a few weeks 
the disease will appear to be cured; but in general this 
appearance is delusive, and treatment should not be re- 
laxed simply because the disease is no longer visible on 
the surface. In all cases the patients should be kept 
under observation for several months after active treat- 
ment has been suspended. 



FAVTTS. 405 

Of internal remedies the following may be mentioned: 

Agaricus. — Favus with biting itching in the scalp; 
crusts sometimes spread to other parts of the body ; sen- 
sation as if ice-cold needles were piercing the skin. 

Arsenicum alb. — The scalp is found perfectly dry and 
rough, covered with dry scales and scabs, extending 
sometimes even over the forehead, face, and ears. 

Arsenicum iod. — Scalp dry and rough, and covered 
with dry scales and scabs; extend to forehead, face and 
ears; intense itching and burning. 

Bromine, — Malignant scald head, oozing profusely; 
discharge dirty looking, offensive smelling; when the 
skin is dry, extreme tenderness of the scalp; crawling 
beneath the skin of the occiput. 

Calcarea carb. — Scabs are thick, and cover a quantity 
of thick pus; the scabs are large, even one-half of the 
entire scalp being covered with a single scab; eruption 
spreading to the face; burning and itching; glandular 
swellings on the neck. 

Clematis. — Eruption on occiput, extending down the 
neck, moist, sore, with crawling and stinging itching; 
often drying up in scales; itching worse when getting 
warm in bed, and but temporary relief by scratching. 

Cornus circinata. — Dry or moist eruption; scrofulosis, 
with dry spasmodic cough, or tedious chronic cough, 
with mucous expectoration. 

Dulcamara. — In scrofulous children when the crusts 
are thick and the hair falls out; bleeding after scratching; 
glandular swellings in the neighborhood of the eruption. 

Graphites. — Exudation of clear, glutinous fluid form- 
ing moist scabs; secretion from scratching; falling out of 
hair; skin dry and inclined to crack; tendency to ulcera- 
tion. 



406 SKIN DISEASES. 

Jacea. — Thick incrustations, pouring out a large quan- 
tity of thick yellow fluid, which agglutinates the hair. 

Kali carb. — Exudation of moisture after scratching; 
sensitiveness to cold; frequent urination, especially at 
night; dryness and falling out of the hair, in old over- 
treated cases. 

Lappa major. — Scalp covered with a grayish- white 
crust, and most of the hair disappeared; eruption spread- 
ing overhead, face, and neck; moist foul-smelling eruption 
on the head of children; swelling and suppuration of the 
axillary glands; boils all over the body. 

Lycopodium. — Eruption beginning on the back of the 
head; when there are several spots, and when the crusts 
are fetid, thick and bleed easily. Hunger, but a small 
quantity of food fills him up. 

Mezereiim. — Head covered with a thick leathery crust, 
under which pus collects and mats the hair; dry eruption 
on the head, with intolerable itching, as if the head were 
in an ant's nest. White, scaly, peeling off eruption on 
the scalp, extending over forehead and temples. 

Oleander. — Biting itching on the scalp, as if from ver- 
min; worse back part of head and behind ears; better when 
first scratching it, followed by burning and soreness; 
worse evenings when undressing; humid, scaly, biting, 
itching eruption, especially on the back part of head. 

Phosphoriis. — May be used when the follicles appear to 
have been destroyed, and the scalp left smooth and 
shining. 

Psorinum. — Moist, suppurating, fetid eruption, or dry 
eruption; hair dry, lusterless, tangles easily; averse to 
having head uncovered; wears a fur cap even in hottest 
weather. 

Staphisagria. — Yellow, moist, offensive scales; falling 
out of the hair; humid, itching, fetid eruption on occiput, 



TRICOPHYTOSIS. 407 

sides of the head, and behmd ears; scratching changes 
the place of itching, but increases the oozing. 

Sulphur. — May be necessary to help along the action 
of the indicated drug. 

Ustilago. — When there is great moisture, with matting 
and falling of the hair. 

Vinca minor. — Offensive, moist eruption, with brownish 
crust; abundance of lice on the head; hair matted to- 
gether; the hair falls out in single spots and white hairs 
grow there. 

Viola tricolor. — Thick crusts; hair becomes matted; 
urine smells like cat's urine. Swelling of the cervical 
glands; intolerable itching at night. 

Tricophytosis. 

Tricophytosis is an affection of the skin, due to the de- 
velopment of a minute fungus known by the name of the 
Tricophyton tonsurans. The disease itself bears the com- 
mon name of "ringworm." There are four principal 
varieties of the affection, which present appearances dif- 
fering somewhat from each other, due to differences of 
location. These are tricophytosis capitis, barbce, corporis^ 
and genisto-fevioralis. 

Tricophytosis Capitis. 

This variety is almost wholly confined to childhood 
and youth — very rarely, if ever, appearing in adult life. 
The symptom that usually first attracts attention is a 
small, scaly, patch on the scalp, perhaps half an inch in 
diameter, from which the hair appears to have fallen. 
On closer examination, however, it is found that, instead 
of the hairs having fallen, they are broken off a line or 
two from the surface. If an attempt be made to extract 
a few of these short stumps with forceps, it will be found 



408 SKIN DISEASES. 

that many of them do not come out by the roots, but 
break off in the follicle, leaving the lower extremity of 
the root in situ. This fragility of the hairs is a marked 
feature of the disease, and brings it into contrast with 
favus, in which affection the hair-shafts are not notably 
weakened. 

If one of the extracted hair-stumps be examined under 
the microscope, it will be found infiltrated throughout its 
entire extent with the minute spores of the tricophyton. 
This fungus, when it takes lodgment on the scalp, gains 
access to the hair-follicles, into which it descends until it 
reaches the bottom. Here it increases and invades the 
root, and travels up the shaft toward the surface. It 
produces dissociation of the fibres, and thereby weakens 
the hair. After the surface is reached, there is no out- 
side pressure to counteract the pressure from within the 
shaft, and the latter gives way and breaks off. The 
original patch extends centrifugally, and new ones form, 
so that after a few weeks or months there may be a pretty 
complete involvement of a considerable portion of the 
scalp. 

In scrofulous subjects, or those prone to suppurative 
action, the irritation of the fungus may cause the forma- 
tion of little collections of pus on the substance of the 
scalp, which, opening on the surface, give a honey- 
combed appearance to the lesion, to which the older 
writers assigned the name of kerion. 

When left to nature, the affection persists indefinitely, 
apparently as long as the hairs and hair-follicles afford 
sufficient pabulum for the fungus. The ultimate ter- 
mination is baldness. The circular patches on the scalp 
may spread beyond the line of the hair and down upon 
the adjacent uncovered skin; and in the form of tricho- 
phytosis corporis may appear on other parts of the body. 



TRICOPHYTOSIS BARB^. 409 



Tricophytosis Barbae. 

This variety is confined to adult males, and appears on 

the bearded portions of the face and neck. At its first 

appearance we usually find a small, red, and very slightly 

raised spot. In a few days this develops into a distinct 

ring, with elevated margin, gradually increasing in size, 

and new spots and rings appearing. Accompanying 

I these lesions we may have pustules, tubercles, and some- 

I times considerable infiltration of the integument — in fact, 

I something not unlike the kerion of children. If shaving 

I be practiced, the irritation is increased. The hairs some- 

i times break and sometimes fall out, and, if examined 

i microscopically, will be found infiltrated with the fungus. 

Tricophytosis Corporis. 

This is the ordinary ringworm of the body, and is too 
I familiar to need any special description. Appearing at 

I first as a small red spot, it soon assumes the annular form, 
ii bounded by a slightly reddened and raised periphery. 

' The center of the patch is apparently healthy, or, at 
j most, slightly reddened. When two neighboring rings 
extend until they meet, the elevated margins which are 
i in contact melt away, and we may have a figure eight, 
Ij or some similar form. 

II This form of tricophytosis rarely gives rise to much in- 
i convenience by itself, except in tropical countries, when 
! this fungus is found to flourish with a vigor not met with 
; in cooler regions. 

Tricophytosis Genito-Femoralis. 

i| This is not a very uncommon variety of ringworm, and 
is almost wholly confined to adult males. The usual loca- 
27 



410 SKIN DISEASES. 

tion is at the tipper and inner aspect of the thigh and 
contiguous parts. It generally involves a portion of the 
scrotum as well as the thigh. 

The diagnosis of t. capitis is usually easy, as the 
broken-off hair-stumps are characteristic. T. barbcs, when 
seen early, and before marked inflammatory action has 
changed the aspect of the part, ought to be recognized 
without difficulty, but later in the course of the disease it 
might be mistaken for eczema barbae, or so-called non- 
parasitic sycosis. Ringworm of the body is recognizable 
under almost any condition that can be imagined, and 
tricophytosis genito-femoralis equally so, unless obscured 
by a co-existing eczema. Under all circumstances, how- 
ever, the microscope may be relied on to settle the 
diagnosis. 

Etiology. — Trichophytosis is due to a vegetable para- 
site, and is propagated from one to another by contact. 
Ringworm of the head is usually contracted by the care- 
less habit among children of wearing each other's head- 
gear, and in public institutions by the common use of 
brushes and combs, towels, etc. In nursing infants the 
trouble is sometimes conveyed to the breasts of their 
mothers. 

Ringworm of the beard is perhaps more frequently con- 
tracted at barber shops than elsewhere, from the use of 
contaminated utensils, and may be passed in turn to the 
lips or cheeks of young women. 

Tricophytosis is met with in the rat, cat, dog, cow, 
horse, and perhaps in other animals, and may be con- 
veyed by them to man. Cavalrymen, who are accus- 
tomed to practice their exercises on bare-back horses, 
sometimes contract the genito- femoral variety. 

Treatment. — The cure of t. capitis is by no means 
easy. Methods of treatment innumerable have been and 



TRICOPHYTOSIS GENITO-FEMORALIS. 411 

are being proposed; but none are simpler or more effect- 
ive than the treatment originally proposed by Bazin fort}^ 
years ago. This consists in thorough epilation, combined 
with applications of a solution of bichloride. If the parasite 
is destroyed, the affection ceases; hence the first object is to 
secure destruction of the tricophytoji. The spores, how- 
ever, are deeply buried in the hair-follicle, and are not 
easily reached by lethal applications while the hairs are 
still i7i situ. The first thing to be done, then, is to re- 
move them as thoroughly as possible with the aid of a 
properly constructed epilation forceps. 

Attack the affected spot or spots with forceps, extract- 
ing every hair-stump possible. Many will break off; but 
do not leave a single one visible above the surface. Then 
thoroughly wash with a bichloride lotion, of the strength 
of one to three grains to the ounce. Apply this daily, 
unless it produces too much reaction, in which case dilute 
it, or omit for a few days. At the end of a week, again, 
with forceps in hand, repeat the epilation, as many of the 
broken hairs will have appeared above the surface. Ex- 
tract as many of them as possible, and continue this treat- 
ment as long as necessary, which may perhaps be six 
weeks or six months, according to the extent of the dis- 
ease, or the intelligence and care with which the treat- 
ment is carried out, remembering that patience and bi- 
chloride will succeed in the end. 

The following makes a good application: 

9^. CarboHc acid. 

Chloral, 

Tincture Iodine, aa ^jjj. 
M. Sig. : Apply once a day with a brush. Three or 

four times for ringworm. 

Ringworm of the beard demands and will respond to 
the same treatment. 



412 SKIN DISEASES. 

Ringworm of the non-hairy parts is a very readily 
curable affection. Sulphur ointment, any form of mer- 
curial ointment, tincture of iodine, or chrysarobin dis- 
solved in traumaticin. A few applications of either of 
these will prompty remove the trouble. 

Ringworm of the crotch may be treated in a similar 
manner, without epilation — an excellent application be- 
ing a solution of six or seven grains of chrysarobin in an 
ounce of traumaticin. 

Internal remedies: 

Sepia and Tellurium are adapted to the ringworm 
variety, as occurring on either body or scalp. 

See remedies under " Favus." 

Chromophytosis. 

Chromophytosis is a parasitic affection characterized by 
the appearance of yellowish-brown spots on the skin. 

The discolored spots are in the beginning small and ir- 
regularly scattered over the invaded surface. They are very 
slightly, if at all, elevated, and are covered with minute, 
barely perceptible scales. The affection is usually con- 
fined to the trunk and upper extremities, almost never 
appearing on the lower limbs. Its favorite seat is the 
chest and back; but it may spread to the neck and down 
upon the abdomen, and upon the arm between the 
shoulder and elbow. The macules may be very numer- 
ous, and many of them not larger than a pea; or they 
may coalesce by mutual extension, and form patches of 
considerable size. 

The progress of the affection is slow; and it is not un- 
common to meet with cases in which the lesions have ex- 
isted for several years. It is sometimes met with in the 
strong and hearty, but most commonly in those who are 
enfeebled by chronic disease, and is especially frequent in 



ONYCHOMYCOSIS. 413 

those who are suffering from phth;sis or syphilis. It was, 
in fact, at one time classed as a symptom of phthisis. 
This was, of course, before the true nature of the disease 
had been ascertained. It is usually more noticeable in 
winter than in summer, a fact explainable by the lighter 
clothing and more frequent ablutions in warm than in 
cold weather. Itching is sometimes present, but is rarely 
severe enough to seriously incommode the patient. 

Etiology. — Chromophytosis is caused by the develop- 
ment of a minute fungus, called the microsporon andonini 
among the superficial epidermic cells. Being of a para- 
sitic nature, it is presumably contagious. 

Treatment. — This affection is easily cured, provided 
proper treatment is instituted and persisted in. The 
one prominent indication is to destroy the superficial 
epithelial cells, and bring about their exfohation, bringing 
with them the parasite. The list of agents that will ac- 
complish this is a long one; but those found most gen- 
erally useful are lotions of bichloride, tincture of iodine, 
sulphur ointment, and chrysarobin. If seven or eight 
grains of the latter be added to an ounce of traumaticin, 
and painted upon the spots for several days in succession, 
the epidermis will soon desquamate. For the treatment 
to be effectual, it is necessary that every spot, no matter 
how minute, should receive the selected application. 
This is rarely done the first time, and the case should be 
inspected weekly by the physician, and the applications 
made by him so far as practicable. It must not be forgotten 
that the under clothes need disinfection or destruction; 
otherwise the affection is very liable to recur. 

Onychomycosis. 

This term is used to designate disease of the nails due 
to the attack upon them of vegetable parasites. The 
name of the fungus is the achorion. 



414 SKIN DISEASES. 

Speaking generally, the effect of the attack of the fun- 
gus upon the nail is to thicken it, to render it brittle, to 
break it up into layers, and to make it opaque, or it may 
be yellowish. The seat of the fungus growth is shown in 
some cases in the early stage by yellowish specks im- 
bedded in the nail, and the fungus oftentimes attacks in 
the first place the side or the part near the root of the 
nail, giving rise to a certain amount, it may be, of inflam- 
mation and discomfort. 

This condition of nail has been produced in those who 
have attended to children's heads affected with ringworm, 
in one or more nails, and as an independent state of dis- 
ease or preceded by tinea circinata of the fingers or back 
of the hand, which has spread to the nail, and in that 
way infected it. 

The diagnosis is made by paying attention to the co- 
existence of parasitic disease, and by the microscopical 
examination. It must not be forgotten that the nails are 
rendered opaque, thick, and brittle in connection with 
psoriasis, pityriasis rubra, lichen ruber, and the like; but 
in parasitic cases the evidence of the connection between 
the nail and the general disease and the origination of the 
former from the latter is usually clear. 

The treatment is, in the majority of cases, very satis- 
factory, but in order that a successful result may be at- 
tained speedily it is necessary that the parasiticide should 
be made to reach the deeper parts of the nail, and that 
the nail structure should be kept soaked in the parasiti- 
cide lotion. Scrape off some of the loose laminae of the 
nails, then apply every second or third day some strong 
acetic acid to the seat of the change, the whole nail area 
if necessary, taking care not to make the matrix too 
tender; and then keep the nail or nails soaked in a solu- 
tion of hyposulphite of soda (gss to gvj of water). 



INGROWING TOE-NAILS. 415 

Perseverance with the lotion will certainly cure the dis- 
ease. 

There are a few diseases of the nails that can hardly be 
classified, yet are of sufi&cient importance to demand a 
passing notice; and we know of no more suitable place 
than the present one to take them up. The first of which 
we will make mention is that very uncomfortable condi- 
tion known as: 

Ingrcwing Toe-Nails. 

This affection is too well known to need any descrip- 
tion, and we will simply giv^e two methods of treatment 
that have been very successfully used in our practice. 
The first is known as the liquor ferri sesquichlor. treat- 
ment, and the method of using, as follows: 

After disinfecting the wound with corrosive mercury 
apply a few drops of the liquor ferri sesquichlor. , after 
lifting the nail somewhat. Allow this to dry. On the 
second and third days, the same process is repeated. 
Then with delicate forceps try to remove the hard crust 
that has formed. The slight bleeding that ensues is im- 
mediately stopped by a fresh application of the liquor. 
In a few days more the same process of ablation is again 
practiced. After a few applications, thus carried out, the 
nail rots so that it can be removed with the aid of the 
■scissors or a dull knife without causing any pain To 
prevent relapses, it is well to insert fine layers of cork 
under the edges of the new nail as it grows forward. 

The second plan of treatment is preferable in some 
•cases. After cleaning the diseased nail in a soap-bath 
and having dried it thoroughly, the whole nail is smooth- 
ly enveloped with tin-foil. A thin strip of tin-foil is 
pressed in on the side where the nail has grown in, or 
tries to grow in. These strips are kept in their place by 



416 SKIN DISEASES. 

a thin layer of 5^ellow wax, so that in all places where 
the nail touches the flesh some tin-foil lies between them. 
Tin-foil acts not only mechanically, but the constant con- 
tact of these moist and granulating spots with the me- 
tallic foil dries up the affected places in a few weeks and 
causes a more healthy state in the morbid nail. It is a 
great gain for laboring people that they are thus able to 
follow their usual avocations, and it is only necessary to 
renew the dressing three times during the first two weeks. 
The feet must not be bathed during that time, but may 
be cleansed with dry wheat bran. 

Paronychia. 

Paronychia is an inflammation, situated around and be- 
neath the nail, terminating in suppuration. 

It attacks mostly the thumb and fingers, and makes its 
appearance as a dusky-red, extremely painful border, 
either completely or partially surrounding the nail. In a 
few days the pain becomes throbbing in character and 
pus forms, attended at times by more or less constitutional 
disturbance. 

Treatment. — Locally, thepithof the common bullrusk 
has been used with good results. Natrum sulph. is the 
principal internal remedy. 

Paronychia may sometimes be aborted by the following 
simple treatment: Take a handful of fresh wood-ashes; 
pour upon it a quarter of a litre of boiling water, so as to 
get a strong lye. As soon as the patient feels the char- 
acteristic pains of the paronychia, with hammering and 
throbbing, the hand should be put in the hot lye, after 
which it is covered with compresses soaked in the solu- 
tion. It maj^ be necessary to repeat the procedure once 
or twice. 



PARONYCHIA. 417 

A very annoying condition, especially when occurring 
in young women, is "red hands." An excellent oint- 
ment for this condition is the following: 

J^. Lanolin, loo grms. 

Paraffin, liquid, 25 grms. 
VanilHn, o.oi grms. 
01. rosse, gtt. j. 

M. Sig. : Apply a thin coating of this ointment to 
the hands at bed time. 



CHAPTER XIX. 
DISORDERS OF THE GLANDS. 

There are two sets of organs to deal with here — the 
sweat glands and the sebaceous glands. 

I. Diseases of the Sweat Glands. 

The deviations from health may be functional or struct- 
ural; the former include all those cases in which the 
sweat varies in amount and kind, but in which there is 
no change in the actual tissue of the glands or follicles 
themselves; the latter, those in which the sweat follicles 
are likewivSe congested, obliterated, inflamed, enlarged, or 
otherwise structurally altered. 

The disorders may be arranged thus: 

A. Disorders of Function and B. Structural Disorders. 

A. Functional Diseases of the Sweat Glands. 

Hypkridrosis is the term applied to excessive sweating. 
It is, however, not very often an independent form of dis- 
ease. It occurs in connection with general febrile dis- 
turbances, as in pneumonia, phthisis, rheumatism — ap- 
pearing to be "critical" in some cases. It may, how- 
ever, occur as a purely local disease, and then the 
excessive secretion of sweat takes place from the face, the 
hands, the feet, or the armpits, and it is very annoying. 
A similar state of things is natural to some persons. The 
sweat may be very offensive. Hyperidrosis may give rise 
to eczema and intertrigo, as about the feet frequently. 
In some cases hyperidrosis, that is, a freer secretion of 



FUNCTIONAL DISEASES. 419 

sweat than usual, may be conjoined with or followed by 
more or less congestion of the follicles, and then the 
morbid states known as miliaria and lichen tropicus re- 
sult. If the sweat fails to escape it may collect under the 
cuticle, forming sweat vesicles. This is sudamina. 

Probably the most annoying form of this affection is 
that where the feet are the parts attacked. Various 
means have been used with varying success. Dr. Ar- 
mingaud recommends a hypodermic injection of Pilocar- 
pine in cases of fetid foot-sweat. 

Chromic acid has been used with excellent results. 
Frequently, one application of a five per cent, solution of 
chromic acid suffices. The solution should be applied 
with cotton-wool to the soles of the feet and between the 
toes. If there are wounds on the feet, they had better 
be healed before applying the chromic acid. 

Therapeutical indications: 

Bar. carb. — Fetid foot-sweat, with callosities on the 
soles which are painful on w^alking; soles feel bruised at 
night, keeping one awake, after rising and walking. 

Calc. carb. — Foot-sweat which makes the feet sore; feet 
feel cold and damp, as if she had wet stockings; burning 
in the soles. 

Canthar. — Temporary cold sweat on feet; smells like 
urine. 

Carbo veg. — Foot-sweat excoriating toes; toes red, 
swollen; stinging, as if frosted; tip of toes ulcerated. 

Graphites. — Profuse foot-sweat, not fetid as in Sepia or 
Silic. , but the most moderate walking causes soreness be- 
tween the toes, so that the parts become raw; spreading 
blisters on the toes, thick and crippled toe-nails. 

Helleborus. — Humid, painless vesicles between the toes. 
■ lodum. — Acrid, corrosive foot-sweat; edematous swell- 
ing of the feet. 



420 SKIN DISEASES. 

Kali carb. — Profuse fetid foot- sweat; swelling and red- 
ness of the soles; chilblains; stitches in the painful and 
sensitive corns. 

Lac. ac. — Profuse foot- sweat, but not fetid. 

Lycopod. — Profuse and fetid foot- sweat, with burning in 
the soles; one foot hot, the other cold, or both cold and 
sweaty; swelling of the soles; they pain when walking; 
fissures on the heel. 

Mur. ac. — Cold sweat on the feet, evening in bed; 
swelling, redness and burning of tips of toes; chilblains. 

Nitr. ac. — Foul-smelling /^<?/-^ze/^a// chilblains on the 
toes. 

Petrol. — Feet tender and bathed in a foul moisture; feet 
swollen and cold; hot swelling of the soles, with burning; 
heel painfully swollen and red; chilblain; tendency of skin 
to fester and ulcerate. 

Plumbtim. — Fetid foot-sweat; swelling of the feet. 

Podoph. — Foot-sweat evenings. 

Sepia. — Profuse foot-sweat or very fetid, causing sore- 
ness of toes; burning, or heat of the feet at night; 
crippled nails. 

Silicea. — Offensive foot- sweat with rawness between the 
toes; itching of soles, driving to despair. 

Squilla. — Cold foot-sweat; sweat only on toes; soles red; 
and sore when walking. 

Sulphur. — Sweating and coldness of the soles; burning 
soles, wants them uncovered. 

Thuja. — Fetid sweat on toes, with redness and swell- 
ing of the tips; nets of veins, as if marbled, on the soles 
of the feet; suppressed foot-sweats, nails crippled, brittle 
or soft. 

Zincum. — The feet are sweaty and sore about toes; 
also fetid; chilblains from scratching and friction; the 
suppression of sweat causes paralysis of the feet. 



ANIDROSIS. 421 



Anidrosis. 



A disorder of the function of the sweat-glands, char- 
acterized by deficiency or absence of perspiration. 

It is either idiopathic or symptomatic, general or con- 
fined to a location, and derived from ancestors or acquired 
in life from such predisposition, and may or may not be 
permanent. 

This functional disorder of the skin is found apparently 
alone, unaccompanied by any other disturbance of health, 
in which case it is known as idiopathic. A typical case 
is the instance of a person who perspires but little, or ap- 
parently not at all, under conditions which would natur- 
ally provoke or accelerate the secretion of sweat, were 
the glands in their normal condition, as when no effect 
results from moist or dry heat, or diaphoretics. The 
skin is dry and harsh to the touch, such as seen in cases 
of ichthyosis or xeroderma. 

The symptomatic is the more common form, and is 
often found associated with other cutaneous or general 
diseases or nervous disorders, and accompanied by gen- 
eral debility and impaired nutrition. There is the same 
dry, rough skin as in the idiopathic form, and the patient 
feels a tightness of the skin, with an itching sensation. 
This condition is general, as in diabetes; or local, as in 
nervous disorders like certain forms of neuralgia and 
paralysis; and it may be temporary, as in fevers, eczema, 
and psoriasis; or permanent, as in diabetes and tubercu- 
losis. 

Etiology. — Idiopathic anidrosis may be ascribed to a 
faulty development of, or defect in, the sweat-glands from 
liereditary, congenital, or other causes, as shown in the 
ichthyotic, xerodermic, and paralytic conditions, the 
otherwise general good health remaining unaffected. 



422 SKIN DISEASES. 

Symptomatic anidrosis, on the other hand, may be 
ascribed to functional torpor resuhing in deficient .secre- 
tion without structural defects in the sweat-glands, as 
found in cases of eczema, psoriasis, diabetes, and phthisis. 

Prognosis. — In the idiopathic form, this is uncertain 
and unfavorable; but in the symptomatic form it is to be 
determined by the nature and duration of the primary 
disorder. 

Treatment. — In the old school, the concensus of 
opinion seems to be that when treatment is admissible in 
the idiopathic form, benefit is only to be derived by 
stimulating the functions of the sudoriparous glands, and 
by the application of suitable emollients to relieve the 
existing dryness of the skin. In the symptomatic form 
the exciting cause should be removed, and the treatment 
directed to the relief of the subjective symptoms present. 
They claim that the activity of the sweat-glands may be 
restored mainly by diaphoretics. Resort should also be 
made to friction and to the use of alkaline, Turkish, or 
other hot baths. 

Internal remedies may assist in some cases, and those 
heretofore found of benefit are: 

y^thusa. — The skin has a dry, white, leathery ap- 
pearance. 

Natrum carb. — The skin of the whole body becomes 
dry and cracked. 

Phosphorus. — The skin is dry and wrinkled. 

Plumbum. — Dry skin, with absolute lack of perspira- 
tion. 

Potass, iod. — The skin is dried up, and rough, like hog 
skin. 



DYSIDROSIS. 423 



Dysidrosis. 

This name is applied to an acute affection of the sweat- 
glands and ducts, characterized by vesicular eruptions, 
usually located and confined upon the palms of the hands, 
but sometimes upon the soles of the feet; and in either 
case the sides of the fingers and toes may be involved. 
The vesicles at first are small, discrete, and deep; after- 
ward they become confluent and superficial; and, finally, 
disappear 1?y absorption. 

The earliest symptoms of this affection, previous to the 
appearance of the eruption, are a tingling sensation, ac- 
companied by heat and tension of the parts involved. 
When the eruption first appears, the vesicles are minute, 
transparent, and discrete, imbedded deeply in the skin, 
and there they slowly increase and become opaque or 
whitish in color. The end may come here, and the erup- 
tion disappear by absorption, accompanied by slight 
scaling of the parts affected; but, when the affection con- 
tinues, the vesicles grow larger and coalesce, forming 
bullae; and when its course is run, usually in a few days 
or weeks, absorption, or rupture and evaporation of the 
fluid contents take place, and the bullae disappear, leav- 
ing a dry, reddened skin. The reaction of the fluid con- 
tained is acid. More or less pruritus is always present. 

The eruption is usually S3^mmetrically distributed, and, 
when both the hands and feet are involved, it first appears 
on the hands. The duration and severity of the attack 
are increased in persons of impaired health. Such per- 
sons, particularly young women, are predisposed to this 
affection, being in a relaxed and depressed nervous state, 
manifested in part by a mild, continuous hyperidrosis of 
the palmar surfaces of the hands. 



424 SKIN DISEASES. 

Diagnosis. — This affection, when mild, somewhat re- 
sembles sudamina, but, if severe, might be mistaken for 
eczema vesiculosum, or scabies. 

Itching and burning sensations will distinguish it from 
sudamina. 

In eczema vesiculosum there is increased and severe 
pruritus, attended with a hot and reddened surface sur- 
rounding the vesicles, which are of a pin-head or less in 
size; these vesicles rupture early and expose a moist sur- 
face, and the drying exudation forms crusts. In dysi- 
drosis this exposed surface is dry, and in th^ vesicular 
stage unsurrounded with inflamed skin. 

In scabies there is the characteristic burrow, or cunic- 
ulus, leading up to the vesicle, and, in a later stage, 
multiform lesions appear, such as papules, pustules, 
scratch marks, etc., which, together with its favorite 
regions and the reddened surface surrounding the vesicles, 
make this affection distinct. 

Prognosis. — There is always a favorable termination 
to this affection. Its tendency is self-limiting, but re- 
lapses are likely. 

Etiology. — This affection is caused by a disturbance 
of the functions of the sudoral apparatus, both of secre- 
tion and excretion, usually ascribed to disordered inner- 
vation; and occurs in persons suffering from nervous 
depression, weakness, innutrition, and other symptoms of 
neurasthenia. 

Treatment. — This will consist in carefully considering 
every abnormal condition of the patient, and prescribing 
that remedy whose symptoms cover most closely those 
complained of by the patient. As almost any remedy in 
the materia medica may be needed, it would not be 
possible to give the indications here. 



OSMIDROSIS. 425 

Osmidrosis. 

This is that disease in which the odor of the perspira- 
tion becomes so offensive as to constitute "the thing to 
be remedied." 

Osmidrosis may co-exist with other functional de- 
rangements of the sweat apparatus. In general diseases 
the sweat exhibits very peculiar odors — in rheumatism it 
is "rank," in scurvy, "putrid," in chronic peritonitis, 
"musky," in scrofula like "stale beer," in intermittent 
fevers like "fresh-baked brown bread," in fevers, "am- 
moniacal," and so on. When the feet are affected, the 
sweat is sometimes most offensive, especiall}^ in the sum- 
mer time. 

Chromidrosis. 

This term signifies colored perspiration, a condition by 
no means common. The perspiration may be changed to 
a black, a blue, a red, or a green color in certain cases. 
The black {melanidrosis) and the blue {cyanidrosis) va- 
rieties of perspiration are probably the same in nature, 
the substance giving the color being identical, but vary- 
ing in hue in the two cases. 

It generall}^ occurs in hj^pochondriacs, or in women 
with uterine disorders of different kinds. It is seen as a 
symmetrical affection attacking mostly the eyelids, and 
the lower one chiefly, but in other instances and more 
rarely the upper eyelid, the cheeks, the forehead, the 
sides of the nose, the breast, the stomach, and the hands. 
It consists of an oozing of black matter which can be 
wiped away, but only as a rule to quickly reappear. The 
discolored secretion is excited by grief, by emotions, by 
fright, and the like, it is said. 

The disease may be, and often is, simulated. But 
there appears to be no doubt that there is a real chromi- 
28 



426 SKIN DISEASES. 

drosis. The coloring matter is probably indican^ which 
is, as it normally exists, colorless, and occurs patholog- 
ically in human urine. The indican is believed to be 
secreted by the sweat glands in a colorless state, and to 
be acted upon by the air so as to be oxidized blue, or 
brown, or blackish, as the case may be. 

Hsematidrosis. 

Hsematidrosis, or Bloody Sweating, occurs under similar 
circumstances, and is supposed to be due to the escape 
into the sweat glands of blood from the capillaries, in its 
turn the result of great excitement. 

B. Structural Diseases of the Sweat Glands. 

Miliaria and Sudamina. 

These two affections really have no right to be con- 
sidered as separate diseases. Sudamina is the lesser 
degree of miliaria, the contents of the vesicles being acid; 
miliaria is the more developed condition, in which in- 
flammation has occurred and the contents are alkaline — 
in fact, inflamed sudamina. Sudamina have been de- 
scribed as little round vesicles, produced by distension of 
the cutis by sweat, and therefore seated at the orifices of 
the sweat follicles. These vesicles may be attended with 
more or less inflammation. Then the disease is termed 
miliaria. Sometimes the vesicles are reddish (miliaria 
rubra), sometimes white (miliaria alba). These vesicles 
are developed about the neck, axillae, clavicles, and 
trunk, in diseases in which profuse sweating occurs, their 
contents quickly dry; each crop is usually succeeded in 
from three to six days by furfuraceous desquamation. 
The disease is seen in phthisis during summer-time, in 
acute febrile diseases, the parturient state, fevers, and 



LICHEN PROPICUS, OR PRICKLY HEAT. 427 

rheumatism. Since the adoption of a cooler regimen 
in sick-rooms, the disease has been altogether less fre- 
quent than formerl}^ 

Bryo7iia, Amnion, ^nur., Arsen. alb., Ledutn^ and 
Urtica ure7is are the most important internal remedies. 
Sulphur and Apis may be studied. 

A weak carbolated bran bath, followed by dusting with 
either the nitrate of bismuth and starch, or lycopodium 
powder, is the best local treatment. 

Lichen Propicus, or Prickly Heat. 

This has nothing to do with lichen. It is a congestive 
or inflammatory disorder of the sweat follicles of the skin. 
It occurs as the result of the stimulant action of heat 
upon the surface. It is therefore common in hot coun- 
tries, but not rare in this climate. " Prickly heat" is 
general!}^ described as an eruption of numerous papillae 
of vivid red color, about the size of a pin's head, without 
redness of the skin generally, often interspersed with 
vCvSicles .and accompanied by a peculiar tingling and 
pricking sensation, which may be almost intolerable, and 
is excited and intensified by heat, warm drinks, flannel, 
etc. The disease attacks chiefly the parts covered by the 
clothes, the arms, legs, breast, thighs, flanks, and the 
upper part of the forehead. 

The treatment is the same as that for miliaria. 

Hydro-Adenitis. 

This is an inflammatory state of the perspiratory folli- 
cles, ending in suppuration. The disease may occur in 
every region of the body where there are glands, except 
in the sole of the foot; but it is most frequent in the 
axilla, at the margin of the anus, and near the nipple. 
It also is seen on the face. The disease commences by 



428 SKIN DISEASES. 

a crop of, or perhaps only one or two small inflammatory, 
tumors, always distinct, about the size of peas, of bright 
red hue. and at first somewhat like boils; but they are 
unlike boils in the fact that the little inflamed indurations 
begin not on the surface of the skin, in a sebaceous or 
hair follicle, but beneath the skin, which is reached and 
involved secondarily. The suppurating follicles offer no 
prominent "point" or "head," and there is no dis- 
charge till the swelling bursts, when the disease is 
brought to a sudden termination. The causes are said 
to be uncleanliness, friction, the contact of irritants, pus, 
parasites, profuse perspiration, and, according to Bazin, 
the arthritic dyscrasia, syphilis, and scrofula, but nothing 
is known about this. The disease is often mistaken for 
scrofuloderma. 

Cystic Formations (Obstructed Sweat Glands). 

In some cases one sees developed in the skin a cyst, 
which takes its origin in a dilated follicle or sac of the 
perspiratory gland. The follicle of the sweat gland be- 
comes obstructed, and instead of the gland inflaming and 
suppurating the fluid collects and distends the follicle. 
The line of demarcation between hydro-adenitis and 
cyst formation in the early stage is not well defined. 

The continuous application of collodion is the best 
treatment; the cysts, however, may be punctured, and 
the contents allowed to escape; the incisions must, how- 
ever, be deep enough. 

Sudolorrhoea. 

This is characterized by the appearance of one or more 
slightly reddened, barely elevated, and sharply limited 
patches, more or less thickly covered with a few greasy 
scales. These appear occasionally on the scalp; more 



SUDOLORRHCEA. 429 

frequentl}^, however, on the contiguous skin along the 
hairy border; and still more frequently on the chest in 
men — rarely in this region in women. 

The affection is essentially sub-acute in its behavior, 
and chronic in its duration. Vigorous friction will re- 
move the scales and leave a surface not wholly unlike 
that of a dry eczema which has been submitted to the 
same treatment, and occasionally will excite a slight ooz- 
ing of oleaginous matter, quite different, however, from 
the clear but plastic exudation of eczema. If a little 
liquor potasses be rubbed on the spot, we will have under 
the finger a thin, non-adhesive emulsion, and not the 
sticky layer which follows a like application to a patch of 
eczema. 

Besides the regions mentioned, the affection may ap- 
pear on the back, and, according to Unna, on the lower 
extremities. The patches may vary in number and in 
shape, being round, oval, semilunar, or irregular, as if 
made up of several circular patches which had united; in 
fact, it may assume the varieties of form that are familiar 
to us in connection with psoriasis, for which disease it 
is not infrequently taken. 

Sudorrhoea, when left unchecked by treatment, often 
persists, with varied activity, for an indefinite period, even 
for years. 

Nothing definite is known as to the cause of the affec- 
tion. It is possibly due to a micro-organism, but this 
has not as yet been positively shown to be the case. 

Treatment. — There is little difficulty in causing a 
temporary amelioration, and even disappearance, of the 
lesions. Frictions, with precipitated sulphur, sulphur- 
ointment, white precipitate, and applications of chrj^sa- 
robin, will usually be sufficient to restore the skin to a 
comparatively healthy condition, but within a few weeks 



430 SKIN DISEASES. 

after treatment is discontinued we not infrequently see 
evidences of relapse. These must be immediately taken 
in hand, and we can usually count on a complete cure if 
treatment be followed up with needful persistence. 

I know of no homoeopathic remedy that is especially 
useful in this complaint, as I have never had an oppor- 
tunity of treating a case of sudolorrhoea. 

II. Diseases of the Sebaceous Glands. 

The diseases of the sebaceous glands are divided into 
two groups — namely: 

FuNCTiONAiv. — Including seborrhoea (increased secre- 
tion), asteatodes (deficient secretion) and allosteotodes, or 
alteration in the character of the secretion. Retention of 
secretion is usually accompanied by alteration of structure. 

Structurai, — Including diseases of the lining mem- 
brane of the sebaceous glands; retention of the secretion 
and its consequence, and, lastly, congestive diseases and 
inflammatory diseases. 

Seborrhoea. 

Seborrhoea is a functional affection of the sebaceous 
glands, and its chief varieties are Seborrhoea oleasa, 
sicca, and kerativa. 

Seborrhoea Oleasa. 

This variety is characterized by the excessive formation 
of a thin, oily, sebaceous secretion, which flows in ab- 
normal quantity from the orifices of the glands and 
covers the affected parts with a shiny and greasy coating, 
plainly visible to the eye, and on this account annoying 
to the patient. The usual seat of the trouble is the fore- 
head, cheeks, and nose, and especially the latter. If this 
organ be taken between the fingers and squeezed, the 



SEBORRHCEA SICCA. 431 

fluid may sometimes be seen to exude like little droplets 
of sweat. The affection is perhaps more frequent in 
youth, and often lasts for several years, and appears to 
be connected with puboric changes. If the secretion be 
not wiped off, it may lose its watery parts by evaporation 
and leave thin scales, consisting of epidermic cells 
mingled with oil-globules, and more or less dirt and dust 
from the atmosphere. 

Seborrhoea Sicca. 

In this variety there is excessive formation of sebum, 
possessing more nearly the character of the normal secre- 
tion — that is, less fluid than in the last named affection. 
There is also a larger proportion of epidermic cells, and 
these, mingled with the oil, dry upon the skin as thin, 
slightly adhering, and usually circumscribed crusts. The 
affection is usually of an extremely mild inflammatory 
type, with slight redness of the skin underlying the 
scales. It may be found on the situations favored by the 
last mentioned variety, or upon the chest in man and 
-other parts w^here the sebaceous glands are well devel- 
oped, but the hairs not so abundant or long as upon the 
head, except in infancy, during the early periods of 
which it is quite common. 

Seborrhcea Kerativa. 

This affection is rare and peculiar, and the few cases 
that have been observed during recent years have been 
described under a variety of names. It appears to con- 
sist in a hyperplasia of the lining cells of the sebaceous 
glands, associated with keratization in place of the usual 
fatty degeneration of these cells. The result of this 
pathological process when generalized is a condition of 
the skin that may be likened to the surface of a magni- 



432 SKIN DISEASES. 

fied nutmeg grater. The orifices of the sebaceous folli- 
cles are widened, and from them project horny plugs in 
almost infinite number. The affection is chronic in its 
development, spreading gradually until almost the entire 
surface is involved. We have little definite knowledge 
of the subsequent course of the affection. 

Diagnosis. — The diagnosis of seborrhoea oleosa is self- 
evident. S. sicca is to be distinguished, on the one hand, 
from eczema oleosa, and, on the other, from pityriasis, 
capitis. This latter is distinctively an affection of the 
adult scalp, characterized by excessive hyperplasia and 
exfoliation of the horny cells of the epidermis, and 
mingled with but a scant amount of sebaceous secretion. 

Treatment. — lyOtions containing hydrochloric and 
chromic acids — either of which may be employed in the 
strength of from two to four per cent., are highly recom- 
mended by the old school. 

The indications for the homoeopathic remedies are: 

Arsen. alb, — Smutty brown, mottled skin; yellow 
color of face. 

Ammon. mur. — L<arge accumulation of bran-like 
scales, with falling off of the hair. 

Bufo. — Skin greenish, and always looking dirty and 
oily. 

Bryonia. — In long lasting cases. 

Calcarea carb. — Nose shines as from oil. Seborrhoea 
with hypersemia of the scalp and headache. 

Graphites. — Seborrhoea behind the ears. 

Iodine. — Firmly adhering scales, which leave the skin 
red and painful, on removal. 

Kali carb. — Dry hair rapidly falling off, with much 
dandruff. 

Lycopodium. — Seborrhoea on the chin. 



ASTEATODES. 433 

Merc. sol. — Seborrhcea of the genitals, accompanied 
with hyperaemia. 

Mezereum. — Excessive formation of smegma, 

Natrum viur. — Severe itching of the scalp; the hair 
falls out in masses; seborrhcea of the face. 

Plumbum. — The skin of the face shines as if oily, and 
feels oily. 

Phosphorus. — Copious dandruff; falls off in clouds. 

Potass, brom. — Seborrhcea on hairy parts of the face, 
forehead and neck. 

Raphanus. — Skin is greasy and makes the hands greasy 
to touch it. 

Sepia. — Seborrhcea of the genitals in women. 

Sulphu r, — Dandruff. 

Thuja. — White scaly dandruff. Hair dry and falling 
off. 

Vinca minor. — Seborrhcea on upper lip and base of the 
nose. 

Asteatodes. 

This is deficiency of the sebaceous secretion. The skin 
appears to be dry and harsh, and this arises from deficient 
action of the sebaceous glands. Asteatodes is seen in 
hereditary syphilis, and in badly-nourished or uncleanly 
folk. The treatment consists especiall}^ in the use of the 
bath, oil}^ infrictions, generous diet, and cod-liver oil. 

Allosteadodes. 

Alteration in the quality of secretion is the characteristic 
of this form of disease. The secretion may be of various 
colors — yellow (seborrhcea flavescens), or black (so- 
called seborrhcea nigricans). 



434 SKIN DISEASES. 

Structural Diseases. 

Xanthelasma. 

H3^pertrophy of the epithelial lining and adjacent 
structures of the follicle, with fatty degeneration, is 
called Xanthelasma, because of the yellow laminae which 
characterize it. The disease may occur in two forms — 
*' either as tubercles, varying from the size of a pin's 
head to that of a large pea, isolated or confluent; or 
secondly, as yellowish patches of irregular outline, 
slightly elevated, and with but little hardness." These 
are mere modifications of one disease, but may occur to- 
gether in the same person. The disease is seen about 
the face, the ear, and the limbs and palms of the hands. 
The most common form and seat is a yellowish patching 
about the inner part of the eye; the disease is symmetri- 
cal; the cuticle over the diseased part is unaffected. It 
never occurs in children; but it is fairly common in 
middle and senile periods of life. In a small proportion 
of cases, that are very severe, jaundice with enlargement 
of the liver is met with. When jaundice occurs, it almost 
always precedes the xanthelasmic patches. The form of 
jaundice is peculiar, the skin becoming of an olive brown, 
or almost black tint, rather than yellow, and the color 
being remarkable for its long persistence. 

Xanthelasma occurs more frequently in females than in 
males, the proportion being two to one. The patches 
occur to those who have been liable to have dark areola 
round the eyes, whether from *' sick-headaches," ovarian 
disturbance, nervous fatigue, pregnancy, or from any 
other causes. Hence their frequency in bilious subjects, 
and in the female sex. 



RETENTION OF SECRETION. 435 

Retention of Secretion. 
Comedones, or Comedo. 

This name is applied to an affection of the skin charac- 
terized by little black points corresponding to the open- 
ings of the sebaceous follicles. If the skin in the neigh- 
borhood of these specks be squeezed between the finger- 
nails, the sebaceous plug which fills the follicles will be 
pressed out. 

This affection is more frequent in youth and adoles- 
cence than at any other ages. The glands of the face are 
the ones that are chiefly affected. 

The causes of comedo are probably similar to thOvSe 
which lead to the development of ordinary acne simplex, 
in company with which affection they are usually found, 
though they sometimes exist without any inflammatory 
complication . 

One author holds that comedones in children differ 
from those of adults in being mainly dependent on local 
causes, on their greater tendency to group and to be more 
closely set, in their involving the hairy scalp, and finally 
to their being generally readily amenable to treatment, 
all that is usually required being friction with a weak 
soft soap and spirit liniment, or a weak sulphur applica- 
tion may be employed in mild cases, preceded by fomen- 
tation with very hot water. 

A peculiar variety is described by Dr. Dumesnil, as 
occurring in two patients. In both cases, the unusual 
eruption occurred on the back, which was also well cov- 
ered with acne. The comedones, in both cases, were well 
marked, the skin not being elevated at the sites where 
they existed. The distribution of these comedones was 
all over the back, though inclined to be discrete. One 



436 SKIN DISEASES. 

peculiarity of the distribution was, that many of them 
were in pairs, the distance between each varying from 
one-eighth or less to about three-sixteenths of an inch, 
with a channel connecting them. By bringing firm 
lateral pressure upon one of the condones in the direction 
of the other; both follicles were emptied from one point, 
and a fine probe introduced at one opening would appear 
at the other. There was but one plug, and that was 
black at both extremities. 

Treatment. — The comedones may in most instances 
be readil}^ removed by pressure with the fingers or aided 
by some one of the many comedone extractors. Sexual 
hygiene is to be enforced if the trouble is to be radically 
cured. 

The principal internal remedies are Baryta carb. and 
Selenium. 

Others may be indicated as follows: 

^(?//a«^.— Comedos in young full-blooded people. 

Cicuta. — Black spots on the skin. 

Digitalis. — Black comedos on the skin of the face, 
which suppurate. 

Mezereum. — Small comedos on the nose and cheeks. 

Nitr. ac. — Black sweat pores in the skin of the face. 

Sabiiia. — Comedos that can be easily pressed out, in 
the cheeks and about the nose. 

Sulphur. — Blackish pores in the face. 

Sumbul. — Numerous black pores on the face; skin 
pale. 

Molluscum. 

This affection is characterized by the development of 
small, umbilicated papules, or tubercles, from the size of 
a small bird-shot to that of a pea, and sometimes even 
larger. 



INFLAMMATORY AFFECTIONS. 437 

The natural color of the skin is usually preserved, and 
the tubercles are not accompanied with inflammatory 
action. If they are squeezed between the fingers, a 
cheesy or sebaceous-looking matter issues from the 
hilum. 

These molluscous growths are met with on the face, 
neck, chest, limbs, and genitals, and may be few or numer- 
ous, coming out one after the other for several weeks or 
months. 

After they have attained a certain size they may per- 
sist for an indefinite period, often at the end shriveling 
up and leaving a little tab of loose skin. 

This affection is most frequently developed in young 
females, but is occasionally met with in males and in per- 
sons more advanced in years. 

The etiology of molluscum is obscure, but the weight 
of evidence appears to be in favor of contagion. In what 
the contagious element, however, consists is unknown. 

The diagnosis of molluscum is easy, as we have sim- 
ply to recognize a non-inflammatory, umbilicated tuber- 
cle, with cheesy contents. 

Treatment. — The quickest way to get rid of them is 
to snip them off with scissors; and, after pressing out the 
remaining contents, to introduce the point of a pencil of 
nitrate of silver. 

Silicea as an internal remedy ranks first, and Teucrium 
next. Bryonia^ Bromine, Calc. ars., Lycopodium, Natr. 
mur. and Potass, iod. complete the list. 

INFLAMMATORY AFFECTIONS. 
Acne. 

Acne is an inflammatory affection of the sebaceous 
glands. 

Acne, in its mildest form of development, consists of a 



438 SKIN DISEASES. 

small papule, usually seated on the face, chest, or back. 
The papule is red, pointed, and may be slightly sore to 
the touch, presenting the usual features of a localized in- 
flammation. The papules may vary in number from one 
or two to several hundred, scattered over the nose, cheeks, 
forehead, temples, chest, and back. The little pimple 
may, on pressure with the finger, present slight firmness, 
indicative of the inflammatory effusion. After a few days 
it may undergo spontaneous resolution and disappear, 
others appearing from time to time to take the places of 
those which have disappeared. This constant succession 
may be kept up for an indefinite period. Instead of 
undergoing resolution, pus may make its appearance, 
either at the summit of the papule or more deeply in its 
structure, thus converting the papule into a pustule. If 
the pustule be squeezed between the fingers, the pus is 
discharged, and with it the somewhat altered contents of 
the sebaceous glands. This form of acne, in which there 
is little or no implication of the tissues surrounding the 
follicle, is usually termed acne simplex, or on account of 
the age at which it is most prevalent, ^lQ^q juvenilis. 

The variety of acne just considered is the special ap- 
penage of youth, and occurs in both sexes between the 
ages of fifteen and twenty-five. Associated with it we 
frequently and perhaps usually find comedones in greater 
or less number scattered over the surface affected by the 
acne. 

In more advanced life — from twenty-five or thirty up 
to fifty years — we may encounter a form of acne charac- 
terized by much larger lesions than those of acne sim- 
plex. In fact, they are large enough to be classed as 
tubercles, and the affection has received the name of acne 
tuberculata, and, when seated on a hardened base, acne 
indurata. In this form there is more or less involvement 



ACNE. 439 

of the tissues surrounding the follicles. These larger 
lesions are usually more sluggish in their develop- 
ment and coarser than those of acne simplex, but go 
through essentially the same phases as the smaller ones. 
That is, there is the same tendency to pus formation, and 
the larger ones may form veritable abscesses, followed by 
permanent cicatrices. 

The causes of the affection are well-known to be local 
irritants, cosmetics, want of cleanliness, exposure to heat, 
cold winds, some varieties of soap, all debilitating causes, 
too rich or insufficient food, onanism or sexual excesses, 
liver, stomach or uterine derangements, and any cause 
that may lead to congestion of the face. Scrofulous sub- 
jects are very prone to this form of skin disease. 

Acne tuberculata is not a very common affection in 
women; but when not associated with intemperance will 
usually be found accompanied by disease or derangement 
of the uterine or ovarian functions. 

Gastric and hepatic disturbances, associated with con- 
stipation, are unquestionably important factors in the 
causation of acne, and too free indulgence in alcoholic 
stimulation is well recognized as the promoter of acne 
tuberculata in men who are advancing from youth to 
middle age. 

Treatment. — Time alone, without special medical treat- 
ment, is sufficient in many cases of acne simplex in young 
persons to bring about a cure. Acne simplex is in a certain 
sense a self-limited affection, but this limitation is not a 
matter of weeks or months but of years, and the patient 
who leaves the affection entirely alone may usually count 
on six or eight years of annoyance. The majority prefer 
a quicker cure, and to that end consult the physician. 
Now, the " cure " of an acne involves two quite different 
questions. The first relates to the speed}^ removal of the 



440 SKIN DISEASES. 

existing eruption, and the second to the prevention of the 
ever-recurring tendency to relapse. 

Baehr says that acne patients are very hard to treat, as 
they generally feel so well that a restriction in their diet 
is hardly ever taken with good grace, or strictly followed 
out. 

Hebra says: " I must confess that, in spite of many ef- 
forts, I have not yet succeeded in finding a remedy by 
which acne can be prevented from developing itself, or 
quickly got rid of when established. 

In acne simplex the measures best calculated to pro- 
mote disappearance of the eruption are: Puncture of the 
papules and pustules; hot fomentations, in cases charac- 
terized by marked inflammatory action; stimulant and 
discutient applications in those of a more sluggish nature. 
It is good practice in every case to puncture the papules 
with a lancet- point, and at the earliest possible moment. 
If pus has already formed, this should be vSqueezed out. 
Hot fomentations for several minutes should then follow, 
and the fomentations with water, as hot as it can be 
borne, repeated night and morning. 

In subacute cases an artificial irritation should be set 
up by nightly rubbing with green soap. Usually in a 
v^eek, or in less time, the skin will be inflamed to as great 
an extent as the patient's endurance will permit. Sooth- 
ing applications should now be employed, and in a few 
days the irritation will subside, accompanied with des- 
quamation of the outer layers of the cuticle. This will 
be followed by a greater or less disappearance of the 
eruption. If necessary, the applications may be repeated. 
In like manner, sulphur, either pure or diluted with some 
violet powder, may be applied with a ladies' puff. Chrys- 
arobin, in the strength of four or ten grains to the ounce 
of traumaticin, effects similar results. In the use of 



ACNE. 441 

chrysarobin, however, it will be wise to commence with 
rather mild applications confined to the papules them- 
selves, and not permitted to spread to the adjacent 
healthy skin, as this drug when too freely applied to the 
face may set up a considerable degree of inflammation, 
almost simulating erysipelas. 

Dr. Hutchinson advises the passage of the cold 
urethral sound every third day in cases that are attended 
with or caused by hypersemia or irritability of the genital 
organs. In females, he orders hot water vaginal injec- 
tions every other night, and claims in both instances suc- 
cessful results. 

The following ointment is highly recommended: 

9= Resorcin, 2 to 5 parts. 
Zinci oxid. 

Pulv. amyH., aa 5 parts. 
Vaseline, 10 parts. 
Fiat vinguentum. Sig. : Apply to parts as often as occupation of 
patient will permit. 

Dr. Piffard says: " The effect of internal medication 
in acne simplex sometimes appears to be very striking, 
and at other times absolutely ?2z7. The drugs which we 
have found most useful are, in ordinary cases, calc. sul- 
phurate, arsenic, and ergot. The first of these is decid- 
edly the most useful, and may be given in doses of one- 
tenth to one-half a grain two, three, or four times daily, 
bearing in mind that the more acute the process the 
vsmaller the dose should be, while in sluggish and indo- 
lent lesions it should be pushed to the maximum. 

The dosage of arsenic should be governed by the same 
principles. Ergot was introduced into the treatment of 
acne by Dr. Denslow. It has appeared to me to be spe- 
cially useful in the treatment of pustular acne in females. 
29 



442 SKIN DISEASES. 

Whether it directly affects the local circulation, as believed 
by Dr. D., or whether its primary effect on those cases is 
on the pelvic organs, I do not know. It has also been 
followed by good results in males. 

In patients who are suffering from anaemia, struma, 
etc. , iron and cod-liver oil should form an important pari 
of the treatment. 

In acne tuberculata and indurata the same generat 
principles of treatment are to be followed; except that in 
these forms arsenic has appeared to me to be of very little 
use. On the other hand, iodide of potassium, in doses of 
five to ten grains, has in some instances been followed by 
favorable results. 

The foregoing applies to the removal of the existing 
eruption. The prevention of relapses, or frequent out- 
breaks of eruption, is quite another matter; and success 
in this regard will be due to the accuracy with which the 
practitioner unravels the etiological factors, and is suc- 
cessful in bringing about their removal or amelioration." 

Our first object should be to get at the cause of the 
disease, if possible, and remove that. The dyspeptic 
should avoid pastry, highly-seasoned food, beer and spirits 
of all kinds. The poorly nourished patient should be 
fed on good food, and should have plenty of it. Buck- 
wheat cakes, hot bread, nuts, cheese, fried substances, 
exhilarating drinks, and all sweet and rich articles of 
food should be avoided. In dyspeptic patients, a cup of 
hot water taken a half hour before meals, will often prove 
beneficial. 

The soaps that have been found most useful are, 
notably, sulphur and iodide of sulphur soaps, and the 
Juniper tar soap. I have seen excellent results from the 
use of a soap made from^ the waters of the " Shookum 
Chuck I^ake," and prepared by Boericke and Tafel. 



ACNE. 443 

As for remedies, we should choose that one that meets 
all the symptoms of the case, and not some one that has 
been suggested for acne, for cases differ widely in their 
causes and symptoms. 

One of the following will likely be indicated : 

Antim. crud. — Small, red pimples about the face, and 
on the right shoulder, stinging when touched ; acne in 
drunkards, with gastric derangements, severe thirst, and 
white- coated tongue. 

Antimon. tart. — In obstinate cases, with longing for 
acids, and when there is a decided tendency to pustula- 
tion ; the pustules are thickest on the neck and shoulders, 
and after discharging leave bluish-red cicatrices. May 
be used internally and locally. 

Ajxtium lappa. — Aggravated cases, wnth numerous 
small boils all over the body. 

Arse7iicum. — In chronic cases where the skin is dry, 
rough, and dirty-looking, and when the eruption is most 
marked on the face and extremities ; cachectic acne. 

Asimina. — Itchirg red pimples, appearing first on the 
left, then on the right side ; pustular acne, with itching 
in the evening when undressing. 

Aurum. — Red pimples on the face ; disposition to 
melancholy ; disgust for life, with suicidal tendency ; in 
onanists and syphilitics ; after over-dosing with the 
iodide of potash. 

Baryta carb. — In obstinate cases, especially when the 
papules or pustules are interspersed with comedones; per- 
sons who take cold easily ; wine drinkers ; hysterical or 
scrofulous persons. 

Berberis vulg. — Red, burning, gnawing pimples, sensi- 
tive to pressure, surrounded by red areolae, and leaving 
brown stains ; adapted to indurated acne, associated with 
urinary or hemorrhoidal troubles ; in women with scanty 



444 SKIN DISEASES. 

or suppressed menstruation ; the patient complains of a 
good deal of chilliness. 

Belladonna. — Large, bright, red pimples on the face, 
back, and scapulae, especially in young, full-blooded 
people; fine stinging in the tips of the pimples; frequent 
congestion of the face and epistaxis; aggravation during 
profuse menses, pregnancy and confinement. 

Bovista. — lyarge, scattered pimples on the forehead; 
hard, red pimples, large as peas, on the chest, worse from 
scratching; in delicate women, with thick acrid or cor- 
rosive, greenish-yellow leucorrhoea, after the menses; ill- 
humor. 

Bromine. — Indurated acne in scrofulous individuals; 
aggravated by smoking; swelling and induration of the 
glands of the neck; prone to erysipelatous inflammation. 

Bryonia. — In dyspeptic cases, aggravated by eating 
cabbage, or warm food; or occasioned by suppressed 
perspiration; constipation as a rule. 

Calcarea carb. — Acne on the face and neck; when due 
to sexual excesses; redness of the nose in consequence of 
dysmenorrhoea or amenorrhoea; people who work much 
in water; scrofulous persons; always worse before the 
menses. 

Calcarea phos. — Has been used successfully for similar 
indications after the failure of the carbonate; chronic 
enlargement of the tonsils; red pimples full of yellow pus. 
In young people during puberty. 

Cannabis. — Meets acne rosacea better than simplex 
when there is morning aggravation with burning like 
fire; sj^philitic patients with much headache on top of the 
head. 

Carbo veg. — Pimples on the nape of the neck; red pim- 
ples on the face and chin; young people, with aggrava- 
tion from eating butter or pork; lymphatic swellings with 



ACNE. 445 

suppuration and burning pains; dyspeptics, when the 
most innocent food disagrees. 

Causticum. — Eruption on the face, more fek than seen; 
yellow color of the face; papulous eruption between the 
eyebrows above the nose; dark-haired persons; in cases 
which have not been improved by Ars., Hepar, or Sul- 
phur ; aggravation from cold, with sensitiveness to cold 
air. 

Chelidonium. — Pimples and pustules in groups of three 
or four on the face, except the chin; chiefly on the left 
side; acne dependent upon liver derangement. 

Adea rac. — Acne in women, dependent upon gastric, 
ovarian, or uterine derangement; melancholy persons. 

Conium. — In obstinate, indurated acne occurring on 
the face; aggravation from suppressed menses; swelling 
of the parotid or submaxillary glands; fetid, smarting 
perspiration; adapted to scrofulous persons and old maids. 

Eugenia. — Pimples on the face which are painful for 
some distance around; at times useful in the indurated 
form. 

Granatum. — Pimples on the forehead and left temple 
with sore pain; they suppurate, and on drying leave 
nodules; itching in different parts of the body as if pim- 
ples would break out. 

Graphites. — Pimples in persons inclined to obesity; 
particularly females with disposition to delaj^ed menstru- 
ation; aggravation during, after, and from suppressed 
menstruation; the skin is very dry, inclined to crack, and 
easily tends to ulceration. 

Hepar. — Painless pimples on the nape of the neck, 
forehead, and chin; crusty pimples on the face in young 
people; swelling and suppuration of glands; skin yellow 
and unhealthy, every small injury suppurates; cough 
with rattling in the chest but no expectoration. 



446 SKIN DISEASES. 

Iodine. — Indurated acne in scrofulous subjects with 
ulcers in the throat; adapted to young persons with dark 
hair and eyes; and rough, dry skin; skin insensible and 
of a dirty yellow color. 

Kali bich. — Face covered with a profuse eruption re- 
sembling acue; when pustules form they resemble small- 
pox pustules; in persons with loud rattling cough and 
stringy expectoration; especially suitable for fat, light- 
haired persons. 

Kali carb. — Small pimples on the face, chest, and back, 
with redness and swelling; deficient perspiration; cases 
aggravated by suppressed menses; rough, chapped skin 
of the hands; dry, parched skin of the face; persons in- 
clined to pulmonary difficulties. 

Kali mur. — Pimples on the face with thick white con- 
tents, caused by a disturbed action of the follicular 
glands. 

Kreasote. — Acne worse after menstruation, or from 
getting heated; dry pimples on the forehead; greasy 
pimples on the right cheek and chin; sad and irritable in- 
dividuals, always worse after the menses, or from getting 
heated. 

Ledum. — Red pimply eruption on the face; small pim- 
ples on the root of the nose; in rheumatic persons or 
drunkards, also when greatly aggravated by heat. 

Lycopodium. — Red pimples in clusters, between the 
scapulae and on the nape of the neck; after the failure of 
Sulph., Rhus, or Hepar ; dyspeptic ailments; red sand in 
the urine; cold feet; constipation. 

Me7xu7'ius sol. — Indolent bluish-red papules, especially 
on the lower extremities; dirty yellow color of the skin, 
with glandular swellings; in syphilitic and scrofulous 
persons. 

Mezereum. — Single pimples on the thighs; red pustules 



ACNE. 447 

with inflamed areolae on the outer side of the extremi- 
ties; in scrofulous individuals, and in persons who have 
alread}^ taken mercury; in those who have attacks of 
intercostal neuralgia. 

Nabalus. — Pimples on the face, about the nose, upper 
lip and chin. 

Natrum mur. — When the skin between the acne points 
looks as if besmeared with oil; aggravated after violent 
exercise, and periodically. 

Nitric ac. — Many small pimples on the forehead, just 
below the hair; painful pimples on the chin with hard, 
red areolae; skin dry, scaly; brown-red spots on the skin; 
after the abuse of mercury; dr3mess of the tongue and 
throat; itching mostly at night. 

Nux juglans, — Variousl}^ sized reddish pimples and 
pustules on the face, chiefl}^ around the mouth; large, 
painful blood-boils on the shoulders, and in the hepatic 
region; adapted to all stages of acne. 

Nux vom. — Dyspepsia with constipation; small fetid 
ulcers in the mouth and fauces; persons who use coffee, 
wine or liquors, tobacco, or who have been allopathically 
drugged; sedentary habits. 

Phos. ac. — Smooth, red pimples with red areolae on the 
forearm, knees and leg; large, red pimples on the face 
and scapulae, only sensitive to the touch; acne in weakly 
persons, onanists, and victims of spermatorrhoea; also 
when due to suppressed perspiration, or loss of animal 
fluids. 

Phosphorus. — Acne in persons predisposed to bronchial 
and lung trouble; of hemorrhagic diathesis; lean and 
slender individuals with painless diarrhoea; aggravated 
from salt and camphor. 

Picric acid — Severe and chronic cases; eruption on 
face, especially on chin and along edges of the sides of 



448 SKIN DISEASES. 

the nose on either side, of indurated and elevated papules^ 
dark red, painless, but sore to touch, upon the surface of 
which small pustules develop. 

Potass, bromide. — Acne ou the face, neck and shoulders, 
with peculiar yellow points which neither coalesce nor 
burst; frontal headache at night; adapted to both the 
simple and indurated forms. 

Potass, iodide. — Papulous eruption all over, but espe- 
cially on the face and the shoulders; painful sensitiveness^ 
worse at night; in mercurial and syphilitic affections. 

Pulsat. — Acne in mild, gentle persons, or pale, slender 
individuals; delayed or scanty menses; predisposition to 
catarrh or diarrhoea; gastric difficulties; aggravated by 
rich or fat food, pork, pastry, etc. 

Rhus tox. — Acne in hard drinkers or persons addicted 
to sexual excesses; rheumatic individuals, always worse 
during rest; aggravated after getting wet and cold; de- 
bility and tired feeling nearly all the time. 

Rohinia. — -Hard pimples, which take a great while to 
suppurate; great tendency of tumors to become in^ 
durated; in dyspeptics with sour stomach, worse at 
night; nocturnal emissions; increased sexual desire. 

Rumex. — Dense rash of small red pimples; eruptions 
aggravated by wearing flannel; itching on various parts,, 
worse while undressing. 

Ruta. — Itching over the whole body relieved by 
scratching; all parts of the body upon which he lies feel 
sore. 

Sabi?ia. — Acne during pregnancy; desponding and hy- 
pochondriac; desire for acid things. 

Sarsaparilla. — Acne on the nose and face, worse dur- 
ing the menstrual period; acne after the abuse of mer- 
cury, after gonorrhoea suppressed by mercury; burning 
itching of the eruption. 



ACNE. 449 

Sepia — Acne on the chin, aggravated during menstru- 
ation and pregnancy; pimples on the mons veneris, legs 
and flexures of the joints; skin dirty-yellow and scurfy; 
ailments following vaccination and self-abuse. 

Silicea. — Obstinate cases in scrofulous persons; fetid 
sweat of the feet; constipation; aggravated from drinking 
wine, from getting cold or wet. 

Sulphur. — In acne vulgaris with black pores in the 
face; red, itching pimples on the nose, lip, around the 
chin, and on the forearm; furunculosis; chronic cases. 

Su7nbul. — Smooth, small, reddish spots on the fore- 
head; black pores on the face; the least draught of air is 
felt down the spine; debility. 

Thuja. — Acne, especially on the wings of the nose; 
dirty, brownish color of the skin; sweet, honey-like per- 
spiration; aggravated during menses; after over-heating; 
after eating fat meat, onions, acids and sweets; after 
drinking beer or wine; after using tobacco, sulphur and 
mercury. 

Verat. alb. — Pimples on the right labium just before 
menstruation. 



CHAPTER XX. 

DISEASES OF THE HAIR AND HAIR FOL- 
LICLE. 

Diseases of the Hair. 

Diseases of the hair may be divided into those of Aug- 
mented and Diminished Formation, Abnormal Direc- 
tion, and Alteration in Physical Aspect. 

Augmented growth may be congenital, of varying ex- 
tent, from small localized growths, such as little hairy 
moles, to the extensive tracts covering more or less of 
the body, as in the "hairy man" described by Mr. 
Crawford. Stimulation has a tendency to augment the 
growth of hair, if the formative power is normal. Dur- 
ing convalescence a freakish, reactionary growth, in odd 
and unusual places, sometimes takes place. 

Diminished formation of hair is partial or general, com- 
parative (thinning) or absolute (alopecia). It may be 
congenital, accidental, or normal (senile). 

Alopecia. 

When the hair is lost entirely from a part, this is called 
alopecia, or baldness. Parasitic disease and atrophy of 
the bulbs are the most usual causes of localized bald- 
ness; syphilis, violent emotion, atrophy of the scalp, 
and senility are most efiicient in producing an absolute 
or a great amount of baldness. The total loss of hair is 
sometimes seen in early life. 




Alopecia Areata. 



n 



ALOPECIA AREATA. 451 

Alopecia Areata. 

Alopecia areata is an affection characterized by circum- 
scribed patches of baldness on the scalp or other hairy 
parts of the body. 

It usually commences with a single spot, rarely noticed 
until it has attained a diameter of perhaps the third of an 
inch. This spot gradually increases in size, and others 
make their appearance to the number, in some instances, 
of a dozen or more. As the several spots increase in size, 
they encroach on each other until they finally coalesce 
and form patches of considerable size, and if unchecked 
may denude the entire scalp. 

The spots themselves are absolutely deprived of hair, 
the short stubble met v^ith in tricophytosis being absent. 
As a rule, the normal hue of the skin is preserved, but 
occasionally we meet with cases in which a slight conges- 
tion is apparent. Sometimes the reverse is the case, and 
the affected portions appear to have a lessened blood- 
supply.. 

Although most frequently met with on the scalp, and 
usually confined to this region, the disease may invade 
the beard and eyebrows, axillary and pubic hairs, and, 
in fact, cases have been observed in which apparently 
every hair of the body has fallen. 

The cause and progress of the affection vary. In some 
cases they proceed by gradual steps to entire denudation 
of the scalp, while in others spontaneous recovery and re- 
growth of the hair may be observed. The new hair that 
comes in, either spontaneously or as the result of treat- 
ment, is usually fine and silky, and very much lighter in 
color than the surrounding healthy hair, and may even 
be entirely colorless. This early growth is not very 
viable, and the hairs are gradually supplanted by others 



452 SKIN DISEASES. 

Stronger and more normal in appearance, until finally the 
formerly bald patch is to be in no way distinguishable 
from the surrounding hair. 

Diagnosis. — There is, or should be, no difficulty in 
diagnosis, as there is no other affection that presents the 
features of circumscribed and progressive patches of bald- 
ness. 

Prognosis. — When cases are met with in the earlier 
stages, and are subjected to judicious treatment, the prog- 
nosis is almost invariably good. In cases in which it has 
progressed further, the prognosis is less favorable, al- 
though the increase of the area of baldness can generally 
be stopped, even if the hair can not be brought back to 
the already affected portions. Cases, however, in which 
total baldness has already occurred may usually be re- 
garded as hopeless. 

Etiology. — The nature and causes of alopecia areata 
are unknown. On the one side, there are those who 
maintain that it is a purely trophoneural affection; and on 
the other, those who are equally satisfied that it is of 
microbian origin. The specific microbe, however, has 
not been determined with any certainty, and the chief 
support of the parasitic theory lies in the fact that the dis- 
ease frequently appears in certain series of cases as if it 
were spread by contagion. Perhaps both theories are 
right, and that two entirely different diseases exist, in- 
cluded under the same name — one of them nervous in 
origin, and the other parasitic. 

Fragility of the hair, seen oftentimes about the beard, 
is explained by the attack of fungi, or by such causes as 
lead to insufficient nourishment of the hair, whereby its 
fibres are ill-formed, and tend to undergo degeneration. 

Senile baldness is due to an atrophy of the structures 
generally; it commences on the crown of the head, the 



ALOPECIA AREATA. 453 

hair first turning gray; the scalp is dry, thinned, loses its 
subcutaneous fat, and the follicles become indistinct. In 
some people this change takes place at an early age; it is 
either an hereditary or physiological peculiarity. 

General thinning of the hair is most likely to occur 
under conditions which lower the vital energy of the 
patient. The scalp generally is scurfy and dry. This is 
in all probabilit}^ due to the sluggish action which goes 
on. The usual sebaceous matter is not secreted; the fol- 
licles become choked by retained fatty and epithelial mat- 
ter, and the formation of the hair is interfered with. This 
is also the case in eruptive disease and in syphilis. 

The loss of hair in all these cases is an evidence of the 
working of some debilitating cause; it is not remediable 
to the most perfect extent without the use of constitu- 
tional remedies. 

The hair in cases of thinning and baldness is often dry, 
brittle, and twisted or split up. This results from the 
peculiar absence of moisture; in its turn from the dimin- 
ished activity of the circulation of the scalp; in its turn 
again, from the general debility of the system. 

The various other alterations in physical aspect come 
under the head of Parasitic Disease. 

Treatment. — The removal of superfluous hair ma}^ be 
accomplished by shaving, epilation, depilation, bleaching 
and electrolysis; of these agents electrolysis is far the 
preferable. This is easily done by introducing a fine, 
needle-shaped electrode into the papilla and connecting it 
with a galvanic battery. Any acid battery of from four 
to eighteen cells will be sufl&cient. The positive elec- 
trode is taken in the hand. From 25 to 50 hairs may be 
removed at one sitting, being careful not to remove hairs 
near together. 

In the case of total loss, much good may oftentimes 



454 SKIN DISEASES. 

be done. In the first place, all syphilitic taints require 
treatment. Then debility of all kinds must be removed. 
In the cases which occur from a failure of the repro- 
ductive function of hair- forming apparatus, local stimu- 
lation is necessary whenever any downy hairs are visible; 
if these be absent, the scalp atrophied from disease, and 
white and shining, little good will be done. If there be 
cedema, or any tension, though the follicles are distinct, 
tincture of iodine applied over diseased parts every 
two or three days is of service. Shaving the downy- 
haired scalp is also beneficial. 

I have used the following application with excellent 
results: 

^. Ouinise Sulph., dr. jj. 

Bay Rum, ^v. 

Ol. Rosemary, dr. iv. 

Tinct. Canth., gj. 

Glycerine, ^jss. 
M. Sig. : Rub into the scalp every morning with a 

small sponge. 

Some may prefer the following: 

j^l. Carbolic acid, 

Chloral, 

Tinct. Iodine, aa ^iij. 
M. Sig. : Apply once a week with a brush. 

The principal internal remedy is Phosphorus, and the 
next Natrum mur. Others may be indicated for alopecia 
in general, as follows: 

Aloes. — When the hair comes out in lumps, leaving 
bald patches. 

Arsen. — When it falls out in circular patches. 

Calc. carb. — When the bald spots are on the temples. 

Carbo veg. — Falling off of hair after severe illness, or 
after parturition. 



ALOPECIA AREATA. 455 

Fluor, ac. — When there is a syphilitic taint. 

Graph, — Bald spots on sides of the head. 

Helleb. — Falling off of hair from eyebrows and puden- 
dum. 

Hepar. — Bald spots on the head, after headaches. 

Kali carb. — Dry hair rapidly falling off with much 
dandruff. 

Mayicinilla. — Falling off of the hair after severe acute 
diseases. 

Phos. — Falling out in tufts. 

Phos. ac, — Alopecia as a result of debility. 

Vinca minor. — The hair falls out in single spots, and 
white hair grows there. 



CHAPTER XXI. 

VARIOUS LESIONS NOT CLASSIFIED. 
Pernio. 

Pernio, or chilblains, is an inflammation of the skin, 
occurring as a secondary effect of cold, and appearing for 
the most part upon the hands and feet. Occasionally 
pernio attacks the nose and ears, and may appear on any 
part of the body. It commences after exposure to cold 
by slight vesication attended with tingling, itching, burn- 
ing sensations. In mild cases it may terminate in a few 
days with desquamation. In severer cases, remissions 
and exacerbations are prone to occur, and thus prolong 
the disease for months. The parts are usually left in an 
irritable state, and are liable to renewed attacks from the 
slightest causes. Any sudden change of temperature, 
and especially a combination of cold and moisture, may 
renew the trouble. In chronic cases the parts become 
livid or purplish in color, and are more or less swollen 
and itchy. Ulcers frequently form. One author claims 
that the ulcerations of erythema pernio were very fre- 
quent in scrofulous patients. Chilblains present special 
gravity in certain cases, as they might become the start- 
ing point of cutaneous tuberculosis, and are specially 
tenacious when they occur on the fingers of patients 
affected with spina ventosa. 

Prognosis. — Pernio when it becomes chronic may last 
for years, disappearing usually in the summer time, but 
returning again as winter approaches. 



PERNIO. 457 

Treatment. — When there is much inflammation a de- 
coction of marshmallows, locally, acts well. 

Tamus communis tincture is recommended as a topical 
remedy for unbroken chilblains. 

Broken chilblains may be dressed with either Oxide of 
zinc ointment or the Glycerole of calendula. 

Resin ointment is adapted to the ulcers that sometimes 
follow. 

The Galvanic current acts favorably in most cases. 

Paint the affected parts every evening with a mixture 
of 

IJ;. Resorcin, i part. 
Ichthyol, I part. 
Tannin, i part. 
Water, 5 parts. 

This will soon turn to a dry varnish on the skin, caus- 
ing the latter to shrivel and the chilblains to disappear. 

A very successful application consists of compresses of 
cotton moistened with a solution of permanganate of 
potassium. The strength of the solution to be from one 
to three grains to the ounce of water. 

Another excellent application is: 

9;, lodinipur., i part. 
Collodion, 40 parts. 

Dissolve the iodine in the collodion, and apply to con- 
gested areas once daily. 

Chilblains may be relieved by local baths of sulphuric 
acid and water, a liquor-glass of the former to a quart of 
the latter. Ulceration does not contra-indicate. The 
baths, lasting about ten minutes, are employed twice 
daily. 

The tincture of benzoin acts as a preventive. It is ap- 
plied by simply painting it on the skin. The stockings 
30 



458 SKIN DISEASES. 

may be prevented from sticking to the feet by rubbing 
some oil over the benzoin. 

The remedies likely to prove useful are: 

Agaricus. — Violent itching, worse at night; burning in 
the fingers, lower limbs and toes; itching, burning and 
redness of the toes. 

Arsen. alb. — Ulcerated chilblains; red spots on the 
feet; violent tearing pains in edges of ulcers when ex- 
posed to cold; relieved by warm applications. 

Badiaga. — Flesh and integuments sore to the touch; 
sensitive to cold air. 

Bellad. — Bright red shining swelling, with pulsative 
pains; burning in skin when touched; tingling itching, 
worse at night. 

Calc. ^2^^.^.— Discharging pus. 

Cantharis. — Itching and swelling of the fingers; blis- 
ters burning on touch ; burning in the soles of the feet at 
night in hysteric patients; tearing and ulcerative pains. 

Citrus vulg. — Itching of the swollen hands and arms; 
general itching, which prevents sleep. 

Kali phos. — Chilblains on toes, hands and ears, tingling 
and itching pain. 

Nitric acid. — Itching of the feet ; spreading blisters on 
the toes; ulcers with stinging and pricking pains as of 
splinters; offensive profuse perspiration on the feet, caus- 
ing soreness. 

Petroleum. — Broken chilblains, with tendency to fester; 
heel painfully swollen and red with stitches; tips of fingers 
rough, cracked and fissured, with sticking cutting pain; 
unhealthy skin. 

Primus. — Itching on tips of fingers as if frozen. 

Pulsat. — Blue red chilblains with pricking burning 
pain, worse toward evening; redness and swelling of joints 



ACTINOMYCOSIS. 459 

with stinging pains; feet feel hot and swollen with tensive 
burning pains; wandering pains. 

Rhus tox. — Inflamed chilblains with excessive itching; 
aching pains in the legs; worse before storms and from 
getting wet. 

Sulphur. — Thick red chilblains on the fingers which 
itch severely when warm; predisposition to chilblains. 

Urtica dioica. — Has been used both internally and ex- 
ternally with good results. 

Verat. vir. — Intense painful itching; chilblains on the 
nose; prickling in the fingers and toes; used internally 
and loyally. 

Actinomycosis. 

This is a very rare disease, and may best be described 
by the following case as reported by Drs. J. Darier and G. 
Gautier: 

The patient was aged 24. The disease, the etiology 
of which could not be definitely traced, had appeared 
nine months previously. The lesion occupied almost the 
entire right cheek, extending from the inferior border of 
the orbit above, limited on the inner side by the nasal 
furrow, and arrested below at a line corresponding to the 
upper border of the inferior maxilla, and extending over 
the entire cheek-bone. The surface was of a reddish- 
violet, of the color of certain forms of lupus, and covered 
in part by scales. The lesion was somewhat elevated 
and studded with half a dozen hemispherical elevations or 
nipples of about one centimetre in diameter, some of 
them ulcerated at the summit and covered with crusts. 

The diagnosis was established by the abundant pres- 
ence in the pus of minute grains of actinomycosis, each 
drop of pus containing from ten to fifteen of these minute 
bodies. 



460 SKIN DISEASES. 

The case was cured by the electro- chemical treatment. 

This treatment is based upon the decomposition of a 
solution of iodide of potassium (one to ten), in living 
tissues, into iodide and potassium by the galvanic cur- 
rent. To obtain this result. Dr. Gautier introduced two 
platinum needles into the nodules of the tissue, and by 
means of a syringe injected, every minute during the 
operation, a few drops of the solution. The two needles 
were connected with the two poles of a battery. The 
treatment, which was under chloroform, consisted of 
three seances, twenty minutes each, at intervals of eight 
days, with an intensity of fifty milliamperes. 

The patient being enciente, the treatment was inter- 
rupted for fear of compromising the natural evolution of 
the pregnancy. Six weeks after her accouchment a final 
treatment was given, with the result of accomplishing 
what is apparently a complete cure. 

Wash-leather Skin. 

Dr. Ferrier, in 1879, first recorded a peculiar condition 
of the skin in which certain metals marked it with black 
lines; this condition he terms " Wash-leather Skin." 

From an analysis of fifty cases, Mr. Emerson concludes 
that: 

1. As a rule, wash-leather skin does not occur in the 
healthy. 

2. It does not occur in many diseases. 

3. It occurs in patients suffering, as a rule, from dis- 
eases which directly or indirectly affect either the trophic 
or the secretory nerves of the skin, such as renal disease, 
phthisis, erysipelas, and hemiplegia. 

4. Silver is the best metal to use for bringing out 
the marks. 



EFFECTS OF RHUS TOX. ON THE SKIN. 461 

5. It may precede, and in the cases cited did precede, 
bed-sores. 

6. It is of diagnostic value in testing vitality of the 
skin, and the site for the experiment is the lumbo-sacro- 
gluteal region. 

7. So far as one may judge at present, it may be of 
value in foretelling bed-sores; and should this be estab- 
lished it would be of great use, for the proper precau- 
tions might be taken as soon as the black line is diagnosed; 
this, at present, seems to be its only. probable use. The 
pathology of this phenomenon is as yet only conjectural. 

Effects of Rhus tox. on the Skin. 

The toxic action of this species is one difiGcult to ex- 
plain. The first noticeable peculiarity is its choice of 
victims, many persons being entirely devoid of response 
to its influences, many others peculiarly susceptible. 

Another peculiarity is that in many cases it is not 
necessary to even touch the plant to be severely poisoned. 

A third peculiarity is that the plant is more poisonous 
during the night, or at any time in June and July when 
the sun is not shining upon it. Absence of sunlight, 
together with dampness, seems to favor the exhalation of 
the volatile principle ( Toxicodendric acid) contained in 
the leaves. An acrimonious vapor, combined with car- 
buretted hydrogen, exhales from a growing plant of the 
poison ivy during the night. It can be collected in ajar, and 
is capable of inflaming and blistering the skin of persons 
of excitable constitution who plunge their arms into it. 

The symptoms caused by this plant are: First, redness 
and swelling of the affected part, with intolerable itching 
and burning, followed by vertigo, weariness, and a sort of 
ntoxication. Infiltration of the face and eyes, and agglu- 
tination of the lids after sleep; great restlessness, pain, 



462 SKIN DISEASES. 

thirst, and fever. The surface of the skin, after a time, 
becomes studded with confluent bullae where the cellular 
tissue is loose, then a dermatitis follows resembling ery- 
sipelas; this may spread rapidly and finally communicate 
to the mucous membranes. This is followed by swelling 
of the mouth and throat, cough, nausea, and vomiting. 
Rheumatoid pains develop about the joints, and a painful 
stiffness asserts itself in the lumbar region, while the legs 
and arms become numb. Confusion of mind and delirium 
may then set in, during which the patient may become ill- 
humored, restless, and anxious, that he will jump out of 
bed. 

The concomitant symptoms are inflammation of the 
eyes, dilation of the pupil, weakness of vision, and some- 
times diplopia; frequent epistaxis; brown coated tongue, 
with a triangular red tip; swelling of the parotid glands, 
with difficult deglutition; griping in the abdomen; diar- 
rhoea; profuse urination; oppression; rapid pulse; great 
weakness, weariness, and prostration; soreness of the 
muscles, worse while at rest, and passing off when exer- 
cising; sleepiness; and chilliness, followed by fever and 
copious sweat. 

There are almost as many antidotes recommended for 
Rhus tox. poisoning as for the bite of the rattlesnake. 
Prominent, however, among the applications are: Alka- 
line lotions, especially carbolate of soda, alum-curd, and 
hyposulphite of soda, keeping the skin constantly moist 
with the agent in solution. A strong infusion of red 
Sassafras root is strongly recommended. It is applied 
freely to the parts, and gives almost immediate relief, 
and this, too, when other remedies fail. 

The fluid extract of serpentaria has been used in quite 
a large number of cases of rhus poisoning with great sue- 



% 



EFFECTS OF RHUS TOX. ON THE SKIN. 463 

cess. It is best applied by placing cloths moistened with 
the extract upon the affected parts without an}^ friction. 
The internal remedies most likely to pro re beneficial 
are: Agaricus, Apis, Ar^iica^ Belladonna, Biyonia, Croton 
tiglium, Graphites, Gri?idelia robusta. Ledum, Nymphoea, 
Sanguinaria, Sepia, or Verbena urtic^folia. 



INDEX, 



Acne, 437 

Actinomycosis, .... 459 

Ainhum, 336 

Alopecia, . 450 

Alopecia Areata, 451 

Allosteadodes, 433 

Anatomy, 9 

Anidrosis, 421 

Anthrax, 233 

Asteatodes, 433 

Bulla, 51 

Bullous Diseases, 188 

Carbuncle, 233 

Carcinoma, 357 

Chromidrosis, 425 

Chromophytosis, 412 

Chromotogenous Diseases, 307 

Comedo, 435 

Condylomata, 288 

Corns, 304 

Cutaneous Hemorrhages, . 374 

Diathetic Diseases, .... 257 

Dermatol) sis, 332 

Drug Eruptions, 58 

Dysidrosis, 423 

Ecthyma, ... . . 225 

Eczema, 225 

Eczema Barbae, 168 

Elementary L/Csions, Classi- 
fication, 48 

Elephantiasis, 333 



Ephelis, 391 

Epithelioma, ... .... 34^ 

Eruptions of Acute Specific 

Diseases, 9^ 

Erysipelas, 115 

Erythematous Diseases, . . 72 

Erythema, 73 

Erythema Multiforme, . . 73 

Erythema Nodosum, ... 74 

Etiology, 60 

Favus, 402 

Fibroma, 33^ 

Fig Warts, 288 

Fissures, 56 

Follicular Hyperaemia, . . 93 

Framboesia, 126 

Furuncle, 228 

General Observations, . . 33 

Hsematidrosis, 426 

Herpes Labialis, 190 

Herpes Progenitalis, . . . 191 

Hordeolum, 232 

Horns, 305 

Hydroa, 208 

Hydro-Adenitis, 427 

Hypertrophic Affections, . 303 

Ichthyosis, 317 

Ichthyosis Simplex, . . . 318 

Ichthyosis Hystrix, . . . 319 

Impetigo Contagiosa, . . . 216 



466 



INDEX. 



Ingrowing Toe-Nails, . . . 415 

Keloid, 328 

Leprosy, 290 

Lichen Pilaris, 136 

Lichen Planus, 129 

Lichen Propious, , . . . 427 

Lichen Ruber, 133 

Lichen Scrofulosum, . . . 141 
Lichen Simplex, , ... 135 
Local Dermal Inflamma- 
tions, 70 

Lupus 340 

Macule, 49 

Malignant Pustules, . . . 237 

Mammillitis Maligna, . . 335 

Measles, 109 

Medicinal Rashes, ... 94 

Melanoderma, 389 

Miliaria 426 

Milium, 334 

MoUuscum, 436 

Morphoea, 322 

Morvan's Disease, .... 299 

Muscles of Skin, .... 23 

Naevus, 336 

Nails, 24 

Neoplasmata, 340 

Onychomycosis, 413 

Osmidrosis, ..... 425 

Papule, ........ 52 

Parasitic Diseases, .... 392 

Paronychia, ....... 416 

Pathology, 59 

Pemphigus, 201, 219 

Pemphigus Vulgaris, ... 203 



Pemphigus Foliaceus, 
Pernio, ... 
Perspiration, Nature and 

Amount of, . . 
Pithiriasis, .... 
Pithiriasis Capitis, 
Pithiriasis Corporis, 
Pithiriasis Pubis, . 
Pityriasis Rubra, 
Pityriasis Pilaris, . 
Prickly Heat, . . 

Prurigo, 

Pruritus, , 

Psoriasis, .... 
Psoriatic Syphilides, 
Psorospermosis, . 

Purpura, 

Pustule, 

Pustular Diseases, 



Effects 



204 

456 

28 
393 
393 
394 
395 
241 
244 
427 
143 
379 
245 
249 

396 

375 

51 

215 



Rhus Tox. 

Skin, . 461 

Rodent Ulcer, ...... 371 

Roseola, 79 

Rubella, 125 

Rules for Studying Skin 

Diseases, 41 



Sarcoma, . . . . . 

Scabies, 

Scales, 

Scarlatina, 

Sclerma Neonatorum, . 

Scleriasis, . 

Scleroderma, 

Scrofuloderma, . . . . 
Seborrhoea, . . . . 

Seborrhcea Kerativa, . . 
Seborrhoea Oleosa, . . . 
Seborrhoea Sicca, . . . 
Squamous Inflammation, 



358 
396 
55 
114 
328 
327 
325 
257 
430 
431 
430 
431 
240 



INDEX. 



467 



strophulus, 

Stye, 

Sudamina, 

Sudolorrhoea, 

Sunburn, 

Sweat Glands, 

Sweat Glands, Disorders of, 

Sycosis, 

Syphilis, 

Tubercle • . . . 

Tumors, 

Tricophytosis, 

Tricophytosis Barbge, . . . 
Tricophytosis Capitis, . . . 
Tricophytosis Corporis, . . 
Tricophytosis Genito-Fem- 
oralis 



142 
232 
426 
428 
391 
17 
418 
288 
267 

54 
56 
407 
409 
407 
409 



Typhoid Rash, 108 

Typhus Rash, 108 

Ulcers 56 

Urticaria, 82 

Varicella, 107 

Variola 96 

Verrucse, - . 306 

Vesicle, 50 

Vitiligo, 388 

Warts, 306 

Wash-Leather Skin, . . . 460 

Xanthelasma, 434 



409 I Zoster, 196 



5 J.-? 



i. C 



